Case Report: Diabetic ketosis-associated hemichorea-hemiballism in an elderly patient with longstanding poorly controlled type 2 diabetes mellitus

Hemichorea-hemiballism associated with ketotic hyperglycemia is a rare movement disorder. We report a case of right-sided hemichorea-hemiballism occurring in the setting of diabetic ketosis in a 70-year-old man with a 15-year history of poorly controlled type 2 diabetes mellitus. The patient presented with subacute involuntary choreiform movements of the right limbs, accompanied by foot pain, significant weight loss, and multiple diabetic complications. Intensive insulin therapy combined with short-term symptomatic treatment resulted in rapid resolution of ketonuria, stabilization of blood glucose, and marked improvement of the movement disorder. Notably, brain MRI showed no classic striatal T1 hyperintensity. At the 3-month follow-up, the patient remained free of choreiform movements. This case highlights that diabetic ketosis can trigger hemichorea-hemiballism in elderly patients even in the absence of typical imaging findings, and underscores the central role of prompt glycemic optimization