A Case Report of Diabetic Striatopathy: An Approach to Diagnosis Based on Clinical and Radiological Findings

Abstract

Diabetic striatopathy (DS) is an acute hyperkinetic movement disorder characterized by hemiballismus-hemichorea (HBHC) due to nonketotic hyperglycemia. DS manifests a fascinating interplay between endocrinopathy (diabetes), striatal (putamen, caudate nucleus, globus pallidus) pathology, and a dramatic neurological movement disorder, HBHC. The striking hyperintensity on imaging modalities such as computed axial tomography (CT) scan of the brain and T1-weighted magnetic resonance imaging (MRI) of the brain can mislead the clinician to an erroneous diagnosis of a cerebral hemorrhage and/or ischemic infarct, especially in an acute setting. We present an acute case of DS and outline the natural history, semiology, typical radiological findings, and therapeutic options. With careful and thoughtful analysis, an accurate diagnosis can be exacted, sparing the patient unnecessary anxiety and medical costs.

Study of Involuntary Limb Movements as a Presenting Feature in Nonketotic Hyperglycemia

“…This is an uncommon hyperglycemia-induced reversible basal ganglia abnormality manifesting radiologically as hyperdensity on CT scan and hyperdensity on MRI. The prevalence of diabetic striatopathy has been reported to be one in 100,000 [7]. In our study, nine patients out of 11 showed changes in the basal ganglia on neuroimaging.…”

“…No evidence of mass effect or edema was noted. Cases with similar changes on MRI imaging have already been reported in the literature [6][7][8][9].…”

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

“…DS should be considered as a possible differential diagnosis in patients with the abrupt onset of hyperkinetic movement disorders [ 60 ]. With a careful and thoughtful analysis, an accurate diagnosis can be centered, thus sparing the patient unnecessary exams and unfavorable outcomes [ 61 ]. In this context, the of use pTCS may be helpful, especially in acute settings or when MRI is not available or cannot be urgently performed.…”