PT  - JOURNAL ARTICLE
AU  - Girija, Manu Santhappan
AU  - Yadav, Ravi
AU  - Nalini, Atchayaram
AU  - Annapureddy, Jagadish
AU  - Gupta, Manisha
AU  - Mundlamuri, Ravindranadh Chowdary
AU  - Chawla, Tanushree
AU  - Shingavi, Leena
AU  - Vengalil, Seena
TI  - Hyperglycemic Hyperosmolar Syndrome Presenting with Unique Craniofacial Involuntary Movements
AID  - 10.1212/CPJ.0000000000001004
DP  - 2020 Nov 02
TA  - Neurology: Clinical Practice
PG  - 10.1212/CPJ.0000000000001004
4099  - http://cp.neurology.org/content/early/2020/10/28/CPJ.0000000000001004.short
4100  - http://cp.neurology.org/content/early/2020/10/28/CPJ.0000000000001004.full
AB  - 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.