519 - Hyperglycemic Hemichorea in the Elderly Adult

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AK

Alexander Kervyn De Volkaersbeke, MD

Resident Physician
Temple University Hospital Program
Philadelphia, Pennsylvania, United States

Submitter(s)

AK

Alexander Kervyn De Volkaersbeke, MD

Temple University Hospital Program
Philadelphia, Pennsylvania, United States

Case Diagnosis: Hyperglycemic hemichorea in an older adult with impaired mobility and ADLs

Case Description: An 88-year-old male with medical history of diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease status post CABG, seizure disorder on phenobarbital, multiple venous thromboembolic events on anticoagulation, and chronic cerebellar infarcts presented with progressive gait dysfunction secondary to choreiform movements. MRI head revealed T1 hyperintensity of the right striatum consistent with hyperglycemic hemichorea. Gabapentin was discontinued due to sedation effects; risperidone was avoided due to QTc prolongation. A trial of olanzapine 5mg daily with ECG monitoring led to partial improvement in involuntary movements. Despite these gains, the patient still demonstrated significant functional impairments requiring moderate assistance for transfers, inability to ambulate, and dependence for lower body dressing and toileting. Therapy sessions trialed adaptive positioning strategies (abdominal binder, knee immobilizer etc.) to manage chorea and facilitate safe standing and transfers.

Discussions: Hyperglycemic hemichorea is a rare metabolic movement disorder characterized by unilateral, involuntary ballistic movements associated with striatal changes on MRI in the setting of high blood sugars. While often reversible with glycemic control, patients may experience prolonged disability. Management is complicated by limited pharmacologic efficacy and interactions with comorbidities. Rehabilitation plays a primary role in optimizing function and independence. This patient demonstrated measurable improvements in sitting balance, endurance and transfer ability with high-intensity therapy despite persistent motor fluctuations. The case highlights the need for interdisciplinary care, careful antipsychotics management and adaptive therapy techniques to manage hemichorea in older adults with multiple comorbidities.

Conclusions: This case underscores hyperglycemic hemichorea as a rare but disabling complication of uncontrolled diabetes, mimicking a metabolic stroke. Optimal management requires both medical therapy and intensive rehabilitation. Early recognition targets pharmacologic management, and high-intensity PT/OT can substantially improve safety and independence even when complete resolution of chorea is not achieved.