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Type 2 Diabetes Presenting With Persistent Chorea

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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Article Information

Corresponding Author: Mayur Chalia, MD, Department of Neurology, Penn State Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033 (mayurchalia@gmail.com).

Published Online: December 21, 2018. doi:10.1001/jamaneurol.2018.4089

Conflict of Interest Disclosures: Dr Subramanian reports receiving grant support from the National Institutes of Health, Commonwealth of Pennsylvania Tobacco Settlement Funds, American Parkinson Disease Foundation, Anne and Phillip Gladfelter III Foundation, Ron and Pratima Gatehouse Trust Fund, Allergan, Intec, and US Worldmeds and serving on the scientific advisory boards of Teva, Acadia, Adamas, and US Worldmeds.

References
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Abe  Y, Yamamoto  T, Soeda  T,  et al.  Diabetic striatal disease: clinical presentation, neuroimaging, and pathology.  Intern Med. 2009;48(13):1135-1141. doi:10.2169/internalmedicine.48.1996PubMedGoogle ScholarCrossref
2.
Lin  CJ, Huang  P.  Delayed onset diabetic striatopathy: hemichorea-hemiballism one month after a hyperglycemic episode.  Am J Emerg Med. 2017;35(7):1036.e3-1036.e4. doi:10.1016/j.ajem.2017.02.018PubMedGoogle ScholarCrossref
3.
Su  CS, Chang  YY, Liu  KT, Lan  MY, Liu  JS.  Risk factors for prolonged hemichorea-hemiballism caused by hyperglycemia.  Parkinsonism Relat Disord. 2012;18(1):96-98. doi:10.1016/j.parkreldis.2011.06.003PubMedGoogle ScholarCrossref
4.
Lee  D, Lee  D, Ahn  TB, Hong  IK, Kim  DY.  Recurrent hemichorea after a hypoglycemic episode.  Parkinsonism Relat Disord. 2014;20(6):676-677. doi:10.1016/j.parkreldis.2014.03.006PubMedGoogle ScholarCrossref
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Bashir  H, Jankovic  J.  Treatment options for chorea.  Expert Rev Neurother. 2018;18(1):51-63. doi:10.1080/14737175.2018.1403899PubMedGoogle ScholarCrossref
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Dean  SL, Singer  HS.  Treatment of Sydenham’s chorea: a review of the current evidence.  Tremor Other Hyperkinet Mov (N Y). 2017;7:456.PubMedGoogle Scholar
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Williams  KA, Swedo  SE.  Post-infectious autoimmune disorders: Sydenham’s chorea, PANDAS and beyond.  Brain Res. 2015;1617:144-154. doi:10.1016/j.brainres.2014.09.071PubMedGoogle ScholarCrossref
8.
Bowen  J, Mitchell  T, Pearce  R, Quinn  N.  Chorea in new variant Creutzfeldt-Jacob disease.  Mov Disord. 2000;15(6):1284-1285. doi:10.1002/1531-8257(200011)15:6<1284::AID-MDS1043>3.0.CO;2-YPubMedGoogle ScholarCrossref
9.
Suri  R, Rodriguez-Porcel  F, Donohue  K,  et al.  Post-stroke movement disorders: the clinical, neuroanatomic, and demographic portrait of 284 published cases.  J Stroke Cerebrovasc Dis. 2018;27(9):2388-2397. doi:10.1016/j.jstrokecerebrovasdis.2018.04.028PubMedGoogle ScholarCrossref
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Nakawah  MO, Lai  EC.  Post-stroke dyskinesias.  Neuropsychiatr Dis Treat. 2016;12:2885-2893. doi:10.2147/NDT.S118347PubMedGoogle ScholarCrossref
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