508 - Non-ketotic Hyperglycemic Hemichorea in Acute Inpatient Rehabilitation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MU

Mosffa Ullah, BS

Medical Student/MS4
TTUHSC SOM
Odessa, Texas, United States

Co-Author(s)

RW

Roger Wolcott, MD

Program Director
TTUHSC PM&R
n/a, Texas, United States

Submitter(s)

MU

Mosffa Ullah, BS

Medical Student/MS4
TTUHSC SOM
Odessa, Texas, United States

Case Diagnosis: Non-ketotic Hyperglycemic Hemichorea (NHH)

Case Description: A 66-year-old male with type 2 diabetes and hypertension presented to the hospital with involuntary, choreiform movements of the right upper and lower extremities. Labs revealed HbA1c >14%. CT Head revealed T1 hyperintensity in the left basal ganglia, caudate, and putamen. MRI showed abnormal signal in the left striatum, consistent with NHH. He was started on Ingrezza 40 mg daily, along with tight glucose control (100–200 mg/dL) during hospitalization. Upon arrival to inpatient rehabilitation, he required contact guard assist for dressing, grooming, and toileting. Moderate assist for mobility, transfers, and ambulation. Previously, he was independent in all activities of daily living. On physical exam, choreiform movements in the right upper and lower extremities were suppressible with proximal palpation. At discharge, he regained independence in eating, toileting, showering, dressing, transfers, and ambulation over 150 feet, although he continued to demonstrate residual choreiform movements.

Discussions: NHH is a rare manifestation of uncontrolled type 2 diabetes. Neuroimaging typically shows T1 hyperintensity in the contralateral basal ganglia. Though most cases are reversible with glycemic control, residual neurologic deficits can persist. This case underscores the importance of strict glucose control to prevent neurological complications. While choreiform movements often resolve within days to weeks, our patient demonstrated persistent symptoms at discharge, highlighting that recovery may be incomplete or delayed despite normalized glucose levels.

Conclusions:

NHH should be considered in patients with new-onset involuntary movements and poorly controlled diabetes. Rehabilitation and therapy play a crucial role in the recovery of these patients by addressing the functional and neurological impairments that may persist even after glycemic control is achieved. A multidisciplinary approach involving psychological support, patient education, and long-term follow-up enhances outcomes, particularly in older adults or those with comorbidities.