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November 02, 2020Case

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, View ORCID ProfileSeena Vengalil
First published November 2, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000001004
Manu Santhappan Girija
1Manu Santhappan Girija, MD, Senior Resident, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Ravi Yadav
2Ravi Yadav, MD, DM Neurology, Professor, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Atchayaram Nalini
3Atchayaram Nalini, DM, PhD, Professor, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Jagadish Annapureddy
4Jagadish Annapureddy, MBBS,DM Neurology, Senior Resident, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Manisha Gupta
5Manisha Gupta, MBBS, Senior Resident, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Ravindranadh Chowdary Mundlamuri
6Ravindranadh Chowdary Mundlamuri, DM Neurology, Associate Professor, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Tanushree Chawla
7Tanushree Chawla, MD, DM Neurology, Senior Resident, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Leena Shingavi
8Leena Shingavi, MBBS, Senior Resident, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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Seena Vengalil
9Seena Vengalil, MD, DM Neurology, Assistant Professor, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India- 560029
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  • ORCID record for Seena Vengalil
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Citation
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
Neurol Clin Pract Nov 2020, 10.1212/CPJ.0000000000001004; 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.
  • © 2020 American Academy of Neurology

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Topics Discussed

  • Dystonia
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  • Clinical neurology examination
  • Blepharospasm
  • Myoclonus

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