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Diabetic hemiballismus in the context of euglycaemia

An 84‐year‐old white British woman with a background history of type 2 diabetes, Alzheimer's dementia, gout and hypothyroidism presented with a four‐day history of sudden, involuntary left arm and left leg movements. She had venous blood glucose of 4.4mmol/L with normal pH on admission. She had normal inflammatory markers with no signs of acute infection. Initial computed tomography brain imaging showed a known stable meningioma with no acute haemorrhage or infarct. Of note she had an admission, six weeks prior, with falls and raised capillary blood glucose readings. On that admission, her HbA1c was noted to have increased to 146mmol/mol having been 57mmol/mol six months earlier. Her oral hypoglycaemic agents were up‐titrated. There was no documented episode of hyperosmolar hyperglycaemic state.