Diabetic striatopathy: A case series of rare and treatable movement disorder

Abstract

OBJECTIVE: Diabetic striatopathy (DS) is characterized by a hyperglycemic state associated with chorea/ballism, and/or striatal hyperdensity on computed tomography, or hyperintensity on T1-weighted magnetic resonance imaging. To date, there have been only a few case series reported in the literature on this topic. In the present study, we report four cases of DS associated with movement disorders. METHODS: The patients were recruited based on the presence of hyperglycemia associated with chorea/ballism or striatal hyperintensity on T1-weighted magnetic resonance imaging. RESULTS: Four patients with DS (two men and two women), with a mean age of 61 years, were included in our study. Three out of the four patients had a previous diagnosis of type 2 diabetes mellitus. The mean blood glucose level on admission and glycated hemoglobin were 390.25 mg/dl and 12.45%, respectively. Hemiballism was present in two patients: one patient had dystonia and the other had choreiform movement at presentation. The putamen was affected in all patients, with involvement of the globus pallidus and caudate nucleus in one patient. All patients had resolution of their abnormal movements after glucose-lowering therapy, with additional use of anti-chorea medication in three patients. CONCLUSION: DS should be considered in elderly patients who present with chorea/ballism/dystonia and should be accordingly managed with resolution of abnormal movements. In addition, dystonia can be a presenting symptom in DS.

Keywords

• chorea hyperglycemia basal ganglia syndrome
• diabetic hemiballism/hemichorea
• dystonia
• diabetic striatopathy
• hyperglycemic non-ketotic hemichorea/hemiballism