Isayli Iman, Ulloa Nicolas, Childress John
Emergency Medicine, Graduate Medical Education, Aventura Hospital and Medical Center, Aventura, USA.
Cureus. 2022 Jul 28;14(7):e27416. doi: 10.7759/cureus.27416. eCollection 2022 Jul.
We present a case of a 58-year-old male with a past medical history of hypertension and diabetes mellitus presenting to the emergency department with a complaint of abnormal and uncontrollable right arm jerking motions occurring since the afternoon on the day prior to presentation. Arm movements such as these may be consistent with either focal seizures or hemiballismus, a movement disorder classified as a choreiform subtype consisting of involuntary violent movements of an extremity with wide amplitudes. Although oftentimes focal seizures and hemiballismus are associated with neurologic etiologies such as strokes, the second most common cause of hemiballismus appears to be non-ketotic hyperosmolar hyperglycemia. While symptomatic treatment in managing focal seizures and hemiballismus may consist of benzodiazepines and dopamine receptor antagonists, respectively, it is important to treat the underlying cause, which in this case was the non-ketotic hyperosmolar hyperglycemic state associated with this patient's long-standing history of poorly controlled diabetes mellitus.
我们报告一例58岁男性患者，有高血压和糖尿病病史，因出现自就诊前一天下午起发作的异常且无法控制的右臂抽搐运动而到急诊科就诊。这样的手臂运动可能符合局灶性癫痫发作或偏身投掷症，偏身投掷症是一种运动障碍，归类为舞蹈样亚型，由肢体幅度较大的不自主剧烈运动组成。虽然局灶性癫痫发作和偏身投掷症通常与中风等神经系统病因有关，但偏身投掷症的第二大常见病因似乎是非酮症高渗性高血糖症。虽然治疗局灶性癫痫发作和偏身投掷症的对症治疗分别可能包括使用苯二氮䓬类药物和多巴胺受体拮抗剂，但治疗潜在病因很重要，在本例中潜在病因是与该患者长期糖尿病控制不佳病史相关的非酮症高渗性高血糖状态。
