Endocrine Abstracts

Introduction: Diabetic striatopathy (DS) is a rare and potentially fatal complication observed in individuals with uncontrolled hyperglycemia. Its prevalence, estimated at less than 1 in 100,000, underrepresents its true incidence, owing to the lack of knowledge about it in physicians. The highest prevalence was seen in Asia (71.6%), Europe (8.5%), and America (4%). Older Asian women were more affected, however, 6 cases were reported in pediatric patients.

Case presentation: A 65-year-old Asian male patient with a history of poorly controlled type 2 diabetes mellitus (DM) and hypertension for 10 years presented with an 8-day history of unilateral, arrhythmic, involuntary, rapid, and non-purposeful choreiform and ballistic movements of the left arm and left leg. The movements were acute in onset, non-progressive in nature, and not associated with any loss of consciousness or orientation, speech disturbances, and convulsions. The random blood sugar level was 536 mg/dl. Laboratory investigations showed glycated hemoglobin (HbA1c) 11.80%.T1-weighted Magnetic resonance imaging (MRI) of the brain showed hyperintensity involving the right posterior putamen. Based on the presence of occurrence of chorea and hemiballismus along with hyperintensity seen in the right putamen on T1-weighted brain MRI and HbA1c of 11.80%, a diagnosis of diabetic striatopathy was made. Sliding-scale subcutaneous insulin glargine was given to achieve glycemic control. Oral tetrabenazine (12.5 mg once a day) and oral clonazepam (0.5 mg once a day) were given to treat chorea and relax skeletal muscles respectively. After 3 days, glycemic control was achieved and chorea subsided. He was discharged with a suitable insulin regimen and 12.5 mg/day oral tetrabenazine.

Conclusion: This case illustrates a rare condition of diabetic striatopathy in a patient with poorly controlled type 2 diabetes mellitus. The presenting features of this condition often mimic a stroke so definitive diagnosis is required with neuroimaging. The mainstay of treatment remains glycemic control, however, anti-chorea drugs may be needed for symptom management.