3118 Hemichorea under the magnifying glass

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Background/ Objectives There are many different causes of hemichorea, including both structural and metabolic abnormalities. We describe a rare but reversible cause of hemichorea.Methods A case report was written.Results An 86-year-old male experienced recurrent subacute onset progressive left upper and lower limb hemichorea worsening over seven days. Prior to this, he experienced acute onset left upper and lower limb hemichorea two months ago which was attributed to diabetic striatopathy, despite lack of supportive MRI imaging (T1 MRI sequences of the basal ganglia was normal). His hemichorea was partially treatment responsive to antiglycaemic therapy and haloperidol.On examination, there was continuous irregular choreiform movements of the left arm and leg which resolved during sleep. The movements were not distractible. The rest of the neurological examination was grossly normal. His blood glucose levels were normal (7 mmol/L); however, serum magnesium was low (Mg 0.27 mmol/L). His hemichorea improved with magnesium replacement. His severe hypomagnesaemia was probably secondary to longterm proton pump inhibitor therapy for gasto-oesophageal reflux disease.Conclusions/Discussion This case demonstrates the importance of evaluating serum electrolytes for patients presenting with acute hemichorea.

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