Diabetic striatopathy presenting as hemi-hyperalgesia and new onset tingling sensation: A rare case report

Abstract

Background: Diabetic striatopathy primarily is characterized by choreiform movements due to hyperglycemic injury to the basal ganglia in a type 2 diabetes mellitus (T2DM) patient. Hemi-hyperalgesia as a presenting symptom in diabetic striatopathy has not been reported previously. Case presentation: Fifty-eight-year type 2 diabetes female presented to the emergency department with complains of left-sided body pain and tingling sensation in the left upper and lower limbs for 3 days. Along with this, she gave a brief history of involuntary movements of bilateral upper limbs. On investigation, her fasting blood sugar was 28.5 mmol/l, postprandial blood sugar was 43.4 mmol/l, HbA1C was 16.8 %. Computed tomography (CT) head showed hyperdense area in the right caudate nucleus, right putamen, and right cerebral peduncle of the midbrain without perilesional edema suggestive of diabetic striatopathy. She was managed with basal bolus insulin and amitriptyline. She recovered from the symptoms after a week and was discharged on oral hypoglycemic drugs. Discussion: Radiologically diabetic striatopathy is characterized by striatal hyperdensity on CT or on T1 sequence of magnetic resonance imaging (MRI); the pathology behind which is basal ganglia injury associated with acute hyperglycemia. Our case presented with hyperalgesia and new onset tingling sensation on the background of acute hyperglycemia with T2DM. Optimal glycemic control, and management of movement disorder if present is the mainstay of treatment. Conclusion: Although rare, diabetic striatopathy is a serious complication of uncontrolled diabetes mellitus. Strict compliance with medications and diet is required for its prevention.

Keywords

• Diabetic striatopathy
• Type 2 diabetes mellitus
• Acute hyperglycemia
• Basal ganglia