Hyperglycemic Hyperosmolar Syndrome Presenting with Unique Craniofacial Involuntary Movements

Manu Santhappan Girija; Ravi Yadav; Atchayaram Nalini; Jagadish Annapureddy; Manisha Gupta; Ravindranadh Chowdary Mundlamuri; Tanushree Chawla; Leena Shingavi; Seena Vengalil

doi:10.1212/CPJ.0000000000001004

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Abstract

A 54-year-old man, with a twenty-five year history of poorly controlled type 2 diabetes mellitus, presented with 4 days of abnormal movements of the right side of face precipitated by tactile stimulus over his face, upper limbs and trunk. His physical examination revealed right hemifacial spasm precipitated by auditory and tactile stimulus, opsoclonus, blepharospasm, oromandibular dystonia, perioral tremor and myoclonic jerks involving the head and neck particularly triggered by neck extension (video 1,http://links.lww.com/CPJ/A222). The patient also had features of a chronic distal sensory motor neuropathy. He had been unable to take food for nearly 72 hours due to jaw closure dystonia and had developed starvation ketosis.

Received May 8, 2020.
Accepted October 2, 2020.

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Hyperglycemic Hyperosmolar Syndrome Presenting with Unique Craniofacial Involuntary Movements

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