Dr. Cao Hoang Trong, from the Department of Neurology, Neuroscience Center, Tam Anh General Hospital TP HCM, stated that upon admission, Ms. Hoa was conscious, exhibiting hemiballismus (uncontrolled swinging movements on one side of her body), but her limb muscle strength remained 5/5, with no paralysis. She had suffered from diabetes for over 10 years with poor blood sugar control.

Her blood sugar test upon admission was 341 mg/dl, nearly 3-5 times higher than the normal range. Her HbA1c index, which reflects average blood sugar over three months, was 14,59%, indicating prolonged hyperglycemia over several months. A 3 Tesla brain MRI scan revealed bilateral basal ganglia damage, primarily in the right putamen, which caused the hemiballismus due to metabolic dysfunction from high blood sugar.

MRI image showing damage to Ms. Hoa's basal ganglia, a deep brain structure. *Photo: Tam Anh General Hospital*

According to Dr. Trong, hemiballismus is a movement disorder characterized by sudden, uncontrolled, forceful flinging and rotational movements on one side of the body. This condition often links to basal ganglia damage, a deep brain structure vital for motor regulation. Prolonged hyperglycemia can cause metabolic disturbances in the basal ganglia. When glucose is not efficiently utilized, nerve cells switch to alternative metabolic pathways, decreasing inhibitory neurotransmitters like GABA. This deficiency disrupts the balance between excitatory and inhibitory motor systems, leading to excessive motor impulses and violent flinging movements.

Ms. Hoa received treatment to balance her fluids and electrolytes, along with insulin to manage her blood sugar. Concurrently, doctors prescribed medications to calm her overactive nervous system, reduce flinging movements and tremors, and help alleviate stress and improve sleep.

After 7 days, Ms. Hoa's blood sugar stabilized, and her abnormal movements became less frequent and smaller in amplitude. She continued to receive close monitoring and insulin regimen adjustments to minimize recurrence and prevent future neurological complications. Dr. Trong stated that if medical treatment for three months does not control symptoms, doctors might consider interventions such as internal pallidotomy, posteroventral thalamotomy, or transcranial magnetic stimulation.

Dr. Trong examines Ms. Hoa before her discharge. *Photo: Tam Anh General Hospital*

Hyperglycemia-induced movement disorders can improve with early detection and timely metabolic control. When blood sugar stabilizes, abnormal movements typically diminish over several days to weeks. However, if hyperglycemia persists or remains unstable, patients risk severe cerebrovascular damage, recurrent movement disorders, and stroke.

Doctors advise individuals with diabetes to adhere to their treatment plans and attend regular check-ups. If uncontrolled limb movements, speech difficulties, weakness, paralysis, or altered consciousness occur, patients should seek immediate diagnosis and treatment at a neurological specialist facility to prevent long-term complications.

Trong Nghia

*The patient's name has been changed.