hemiballism - hemichorea ( hb - hc ) is characterized by the continuous and involuntary movements of both the distal and proximal part of the extremities . most of cases are associated with diabetes mellitus with poor control and presented in the elderly women . typical brain magnetic resonance imaging ( mri ) presentation shows unilateral hyper - intensity signal over the striatum region , contra - lateral to the symptom side . nonetheless , bilateral hb - hc is seldom reported . here a 85-year - old taiwanese woman with poor controlled non - insulin dependent diabetes mellitus ( niddm ) noted four limbs involuntary movements one week prior to medical attention . a neurological consultation was made and it revealed she had bilateral hb - hc ( first with left sided extremities , which was then ensued with right sided extremities ) . after admission , contrasted cerebral mri was performed ; it showed the evidence of t1 weighted imaging with hyperintensity signal in bilateral putamen regions ( figure 1 ) . the routine laboratory work - up showed that her fasting blood sugar was up to 500 mg / dl and hemoglobin a was 16.2% . during the two - week hospitalization , her bilateral hb - hc was greatly subsided . after she discharged from the ward , her bilateral hb - hc remained silent . the second mri was taken four months after her initial involuntary episode and showed complete resolution of the previously - reported brain lesions . we report the case of a patient with initial hbhc over the left side extremities . the symmetrical focal abnormalities over bilateral striatum of her brain mri taken during the hospitalization correspond to her clinical manifestations . the clinical symptom could be alleviated with intensive correction of hyperglycemia state and administration of low doses of haloperidol . the follow - up brain mri , which showed intact cerebral parenchyma , also echoes the satisfactory treatment . on literature review , most of reported cases are associated with poor controlled type 2 diabetes mellitus in either hypoglycemic or hyperglycemic state as the initial manifestation . the other etiologies are ischemic change contra - lateral to the lesion side , infection , or tumor metastasis . it is speculated by some scholars inflammation process plays a pivotal role in this malady owing to increased level of igg in cerebrospinal fluid examination . however , the definite cause of hb - hc is still uncertain and required advanced studies . in addition few cases have been documented with bilateral hb - hc , and whose efficacy of treatment and neuro - imaging studies are compatible with one another .
hemiballism - hemichorea ( hb - hc ) is a hyperkinetic disorder characterized by continuous involuntary movements of the extremities . 
 it could be associated with non - insulin dependent diabetes mellitus . 
 a very few cases of bilateral hb - hc have been reported until today . 
 we describe here the case of a taiwanese woman ( 85 years old ) presenting with bilateral hb - hc and diabetes mellitus .