Diabetic striatopathy manifesting as severe consciousness disturbance with no involuntary movements

Sato, Hiroki; Hamano, Makoto; Fushimi, Etsuko; Takahashi, Toshiaki; Horikawa, Yohei; Horiguchi, Satoru

doi:10.1111/dme.13526

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…Chua et al [1] found that nearly 7% of patients who presented with chorea did not show any striatal involvement in neuroimaging. Of interest is that 2% of patients may show radiological striatal lesions but no clinically manifested movement disorders (radiologically isolated DS) [1, 3, 19].…”

Section: Resultsmentioning

confidence: 99%

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Dubey

Biswas²,

Ghosh

et al. 2022

Eur Neurol

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Background: Diabetic striatopathy (DS), coined as a generic term, has been defined as a hyperglycemic condition associated with either one of the two following conditions: chorea/ballism or striatal hyperdensity on computed tomography or striatal hyperintensity on T1-weighted magnetic resonance imaging. This review highlights those “gray areas,” which need further exploration to understand better hyperglycemia-induced striatal changes and diverse movement disorder phenotypes associated with these changes. Results and Discussion: We searched in PubMed and Google Scholar the terms “diabetes mellitus,” “movement disorders,” “diabetic striatopathy,” “chorea,” “hemichorea,” “ballism,” “hemichorea-hemiballism,” and “neuroradiology” in various combinations (time range from 1980 to March 2022). We selected the publications about our topic of discussion. Summary: Hemichorea-hemiballismus is the most commonly associated movement disorder in DS, and the putamen is the most frequently affected anatomical region. The exact pathophysiological mechanisms remain elusive. Clinical-radiological discordance is not rare. Complete reversal of symptoms with the resolution of the imaging findings is the most prevalent outcome in patients with DS. Dramatic improvement of chorea can be achieved by either insulin monotherapy or combination therapy of insulin and D2-blocker or, in some cases, even spontaneously. Conclusion: The term “diabetic striatopathy” is ambiguous and controversial. Pathological mechanisms behind clinical-radiological discordance in hyperglycemia-induced striatopathy need further exploration through well-designed studies. We propose a classification of DS that includes 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.

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Section: Resultsmentioning

confidence: 99%

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Dubey

Biswas²,

Ghosh

et al. 2022

Eur Neurol

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“…Non-ketotic hyperglycemia, unilateral limb choreographic dyskinesia, and striatal abnormalities on neuroimaging are typical signs of DS. Previous studies have found that chorea associated with hyperglycemia occurs mostly unilaterally and rarely bilaterally; a few may occur in hypoglycemic states or after correction of hyperglycemia [ 1 , 16 – 18 ], and a few DS cases reported no chorea [ 18 – 20 ] or had nonchoreic and nonballistic movements [ 7 , 12 , 14 , 18 , 21 , 22 ]. The imaging manifestation may also be unremarkable [ 16 , 18 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and imaging features of diabetic striatopathy: report of 6 cases and literature review

Shi

Yue

et al. 2022

Neurol Sci

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Objective To explore the clinical manifestations, diagnosis, treatment, and pathogenesis of diabetic striatopathy (DS) to improve the understanding of the disease and avoid misdiagnosis or underdiagnosis. Methods The clinical, laboratory, and imaging data of 6 patients (5 Asian females and 1 Asian male) with diabetic striatum were analyzed retrospectively, and the related literature was reviewed. Results All 6 patients showed hyperglycemia, 5 patients presented with involuntary movement of unilateral limbs, and 1 with unilateral limb numbness. Besides, 5 patients (except case 3) underwent MRI examinations that showed hyperintensity in unilateral caudate and lentiform nucleus on T1-weighted images. And all 6 patients who underwent brain CT examinations showed hyperdensity or isodensity in unilateral caudate and lentiform nucleus. None had a family history of similar abnormal movements. After blood glucose control and symptomatic support treatment, the symptoms of all patients improved to various degrees, and reexaminations showed that the lesions gradually disappeared. Conclusion Diabetic striatal disease is a rare complication of diabetes mellitus, the result of a combination of different pathogenesis. It is characterized by hyperglycemia, hemichorea, and contralateral striatal T1WI hyperintensity or CT hyperdensity. Both ketosis and nonketotic hyperglycemic hemichorea have typical imaging manifestations. The prognosis is excellent when this disease is detected early, and the lesions can be gradually absorbed and dissipated with glycemic control.

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“…Ds has been reported to occur without chorea and ballismus. sato et al described the case of a 58-years-old male with T1-hyperintense lesions of the striatum, but who presented only with severe altered consciousness [14]. Ds can represent the first manifestation of diabetes mellitus and should be suspected in patients with sudden onset of hemichoreic movements without a prior history of diabetes [15].…”

Section: Biopsy -Histopathologymentioning

confidence: 99%

A few thoughts on diabetic striatopathy – case report and short review

Lupescu¹,

Lupescu²,

Arbune³

et al. 2020

Ro J Neurol.

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Diabetic striatopathy is an uncommon complication of diabetes mellitus, usually characterized by hemichorea-hemiballismus with T1-high signal intensities involving the contralateral striatum. We present the case of an 81 years-old woman with poorly controlled type 2 diabetes mellitus, who was rushed to the hospital for acute-onset right-sided hemiparesis, somnolence and aphasia. Blood analysis revealed hyperglycemia (412 mg/dl) and raised level of glycated hemoglobin (14.5%), while head CT examination showed a spontaneous hyperdensity involving the left caudate and lenticular nuclei, with no edema. Brain MRI was also performed and highlighted T1-hyperintensities at the level of the same structures, with no diffusion restriction. The patient improved significantly under adjustment of insulin therapy. Based on these observations, a diagnosis of diabetic striatopathy was established. We present a short review of the literature regarding this condition and its main characteristics.

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Diabetic striatopathy manifesting as severe consciousness disturbance with no involuntary movements

Cited by 20 publications

References 23 publications

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Neuroimaging of Diabetic Striatopathy: More Questions than Answers

Clinical and imaging features of diabetic striatopathy: report of 6 cases and literature review

A few thoughts on diabetic striatopathy – case report and short review

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