Corea de larga duración asociada a hiperglicemia no cetósica

Abstract

The secondary Chorea to hyperglycinemia represents a neurological infrequent syndrome; its pathogenesis is not fully understood. Currently have been described only case reports, being very few publications in Latin America. Through a systematic review of studies published between 1980 and 2018, significant differences were identified between the types of hyperglycinemia and characteristics of the clinic and image, which can be useful for future research on the underlying pathophysiology. A 75 indigenous female patient without relevant history is described, who presented involuntary continuous and unsustainable movements, at the level of the right upper and lower extremities associated with osmotic symptoms (polydipsia and polyuria) during 3 days. The level of glucose in the blood 470.50 mg / dl without the presence of ketones in the blood or urine, glycosylated hemoglobin 15.4%, the nuclear magnetic resonance reported the hyper density in T1 of the predominant left lenticular nucleus at level of putamen without other alterations. The diagnosis was reached of secondary chorea to non-ketotic hyperglycinemia. Through the treatment the serum glucose level was normalized during the first 24 hours of hospitalization, however, the female patient presented partial improvement in the intensity of the choreic movements, without the disappearance of the same; findings in the control image, suggest aftermaths of cellular damage known as cellular necrosis, ischemia or gliosis caused by the cellular injuries by hyperglycinemia, which contrasts with the prognosis of the female patient with reference to the choreic movements, which persist to a lesser intensity in spite of adequate metabolic control. This condition may be the first clinical expression of the diabetes mellitus or the result of a poor metabolic control of the same, especially among older adults, that is the reason of making previous frequent metabolic controls is necessary to avoid this type of clinical expression.