Diabetic striatopathy: an updated overview of current knowledge and future perspectives

Abstract

Purpose Diabetic striatopathy (DS) is a rare complication of poorly controlled diabetes mellitus (DM), characterized by hyperglycemia associated with chorea/ballism and characteristic reversible basal ganglia abnormalities on computed tomography (CT) and/or magnetic resonance imaging (MRI). We propose a narrative review of the literature on this topic, currently unknown to most, and about which physicians should be aware. We intend to summarize, critically review, and take to mean the evidence on this disorder, describing its typical features. Methods We searched Pubmed for English-language sources using the following keywords in the title and the abstract: diabetic striatopathy, hyperglycemic non-ketotic hemichorea/hemiballism, chorea/hemichorea associated with non-ketotic hyperglycemia, diabetic hemiballism/hemichorea, chorea, hyperglycemia, and basal ganglia syndrome. We collected scientific articles, including case reports, reviews, systematic reviews, and meta-analyses from the years 1975 to 2023. We eliminated duplicate, non-English language or non-related articles. Results Older Asian women are more frequently affected. Suddenly or insidiously hemichorea/hemiballism, mainly in the limbs, and high blood glucose with elevated HbA1c in the absence of ketone bodies have been observed. Furthermore, CT striatal hyperdensity and T1-weighted MRI hyperintensity have been observed. DS is often a treatable disease following proper hydration and insulin administration. Histopathological findings are variable, and no comprehensive hypothesis explains the atypical cases reported. Conclusion DS is a rare neurological manifestation of DM. If adequately treated, although treatment guidelines are lacking, the prognosis is good and life-threatening complications may occur occasionally. During chorea/hemiballism, we recommend blood glucose and HbA1c evaluation. Further studies are needed to understand the pathogenesis.

Further learning of clinical characteristics and imaging manifestations of nonketotic hyperglycemic hemichorea

“…DS would also include patients with a hyperglycemic condition associated with even one of the following: (a) chorea/ballism or (b) striatal hyperdensity on CT or hyperintensity on T1‐weighted MRI. 30 The term “diabetic striatopathy” is ambiguous and controversial. Furthermore, a possible classification of DS has been recently proposed, including symptomatic DS (striatal neuroimaging lesions in association with a clinically evident movement disorder and hyperglycemia), clinically isolated DS (clinically evident movement disorders without striatal changes in neuroimaging), and radiologically isolated DS.…”

Optimizing Blood Glucose Regulation in Type 1 Diabetes Patients via Genetic Algorithm-Based Fuzzy Logic Controller Considering Substantial Meal Protocol

“…Inadequate control of blood glucose levels can lead to severe complications [25]. Hypoglycemia, in which glucose levels fall below the euglycemic range, results in symptoms such as dizziness, confusion, severe cases, coma, and death [26][27][28]. Conversely, hyperglycemia, with glucose levels above the euglycemic range, leads to symptoms such as increased thirst, fatigue, skin issues, frequent urination, dry mouth, and blurry vision, potentially causing longterm complications, such as cardiovascular diseases, kidney damage, and eye and ear defects [29].…”

“…of characteristic equations results in; det (A−λI) = 0 where A is the Jacobian matrix, λ = eigenvalues, and I = Identity matrix+ 0.144λ + 0.003348 = 0(26) Therefore, the solution to the quadratic equation is given as; λ = −0.072 and λ = −0.216(27) Optimizing Blood Glucose Regulation in Type 1 Diabetes Patients via Genetic Algorithm-Based Fuzzy Logic Controller Considering Substantial Meal Protocol…”

Characterization of Diabetic Striatopathy With Repeated Follow-Up Using Multiple Imaging Studies

“…Diabetic striatopathy is a rare disease that causes chorea or ballism, primarily in patients with type 2 diabetes mellitus and poor glycemic control [ 1 - 3 ]. Although diabetic hemiballism/hemichorea, hyperglycemic non-ketotic hemichorea/hemiballism, and other names have been used to describe this disease, diabetic striatopathy has only recently been used to describe the disease [ 1 - 5 ]. The term diabetic striatopathy is a nomenclature that focuses on imaging findings rather than symptoms [ 4 ].…”

“…The term diabetic striatopathy is a nomenclature that focuses on imaging findings rather than symptoms [ 4 ]. Striatal hyperintensity on T1-weighted magnetic resonance imaging (MRI) is a characteristic of diabetic striatopathy [ 1 - 6 ]. However, the relationship between the imaging findings and the clinical course of the disease is not clearly understood.…”