Hyperglycemic hemichorea due to diabetic striatopathy: case-based review

Abstract

Diabetic Striatopathy (DS) is a rare complication of diabetes mellitus (DM) with poor glycemic control and typical neuroimaging findings. DS predominantly leads to a unilateral reversible injury of the basal ganglia resulting in various movement disorders such as hemichorea and hemibalismus. We present a rare case of DS with left-sided hemichorea as a first presentation for a newly diagnosed Diabetes Mellitus (DM) type II and to make a thorough review of this disorder and to provide a practical approach to its management. A 63-year-old female was admitted to the neurology ward with symptoms of involuntary hyperkinetic movements for the left limbs and the left half of the face. The blood samples revealed random serum glucose of 30.8 mmol/l and an HbA1c of 15.13%. The computed tomography of the brain showed asymmetric, unilateral hyperdensity in the right basal ganglia (BG) – the putamen and nucleus caudatus. The patient was managed with Insulin and Haloperidol as the symptoms entirely resolved on the tenth day. In conclusion (DS) is a condition with a good prognosis and reversible clinical and neuroimaging findings after a prompt diagnosis and management. DS should be considered a possible differential diagnosis in patients with abrupt onset of hyperkinetic movement disorders.

Keywords:

• Diabetic striatopathy
• non-ketotic hyperglycemia
• movement disorders
• chorea
• basal ganglia
• diabetes mellitus

Transparency

Declaration of funding

This research did not receive any specific grant from funding agencies in public, commercial, or not-for-profit sectors.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors are indebted to the patient for her informed consent and cooperation, who agreed to use clinical data for this publication. The authors would also like to thank the editorial board of Current Medical Research and Opinion for review and criticism in improving the manuscript.

Author contributions

All authors had a substantial contribution to the conception or design of the work. Mihael Tsalta-Mladenov had a major role in patient follow-up, preparation of the supplemental materials. Mihael Tsalta-Mladenov and Darina Georgieva designed and drafted the manuscript. All authors were highly involved in the data collection, processing, analysis, and critical review of the manuscript. All authors approved of the version pf the current manuscript to be published and agreed on the accuracy and the integrity of any part of the work.