Objective: To describe a rare case of diabetic striatopathy in a woman with type 2 diabetes mellitus presenting with unilateral hemichorea, dysarthria and left hemiparesis

Background: Chorea is a hyperkinetic movement disorder characterized by random, irregular, and purposeless movements involving various body segments. Hemicorea affects only one side of the body and is typically associated with vascular lesions in the contralateral subthalamic nucleus, basal ganglia or thalamus. Other etiologies of hemicorea with focal lesions include opportunistic infections in the context of human immunodeficiency virus and diabetic striatopathy.

Diabetic striatopathy, also known as non-ketotic hyperglycemia-induced hemicorea, is a rare neurological complication of diabetes and it is characterized by hemicorea or hemiballismus associated with hyperdense changes on CT or hyperintensities on T1-weighted MRI sequences in contralateral basal ganglia in patients with poorly controlled diabetes mellitus.  Glycemic control is usually the first line of treatment, followed by antidopaminergic medications less often, which results in symptoms improvement.

Method: .

Results: Case report: A 68-year-old female patient with a history of non-insulin-dependent type 2 diabetes mellitus, hypertension, and hypothyroidism presented with stereotyped choreic movements predominantly affecting the left side of her body, associated with moderate shoulder and posterior neck pain, dysarthria and left hemiparesis. On physical examination, choreic movements were observed on the left side of the body, trunk, and head. Initial investigations revealed hyperglycemia (HbA1c 11.1%) and decreased renal function (creatinine 1.51 mg/dl), with a normal CT scan of the brain. She was initially prescribed levodopa and amantadine, followed by valproic acid, but without improvement. Lumbar puncture ruled out infectious etiologies. MRI revealed hyperintensity in the right lentiform nucleus, consistent with diabetic striatopathy. Internal medicine managed her comorbidities, optimizing her glycemic and blood pressure control. Quetiapine was initiated, leading to significant improvement.

Conclusion: Diabetic striatopathy is a rare neurological condition affecting diabetics that is commonly misdiagnosed as hemorrhagic stroke. However, it is important for physicians to be aware of this condition because if properly treated, it has a good prognosis and can lead to improved life quality for patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diabetic-striatopathy-with-stroke-like-symptoms-a-case-report/