Objective: To illustrate the spectrum of diabetic striatopathy by presenting 3 cases with different clinical and neuroimaging findings.

Background: Diabetic striatopathy is a rare complication of diabetes mellitus (DM). It predominantly affects the striatum and external pallidum, leading to a spectrum of movement disorders. The most common neuroimaging findings of diabetic striatopathy are striatal hyperdensity on CT, and T1-weighted hyperintensity and T2-weighted hypointensity on MRI. Imaging findings of striatopathy have also been described in neurologically asymptomatic patients with DM.

Method: One year, single-center, consecutive case series of hospitalized patients with diabetic striatopathy.

Results: Case 1: A 46-year-old man with poorly-controlled type 2 DM presented with metabolic encephalopathy. Neurological exam did not reveal focal deficits or abnormal movements. Head CT showed hyperdensity of the bilateral caudate. Head MRI revealed bilateral pallidal microhemorrhages (SWAN sequence). Encephalopathy resolved with the management of metabolic disturbances.
Case 2: A 66-year-old woman with poorly-controlled type 2 DM, hypertension, hyperlipidemia, and left corona radiata stroke with mild residual weakness presented with acute right-sided hemichorea. Head CT with angiography revealed left putaminal hyperdensity and increased blood flow. Head MRI was normal. Glycemic control was optimized, and hemichorea gradually improved over the next 4 months.
Case 3: A 78-year-old woman with poorly-controlled type 2 DM and chronic kidney disease presented with 2 weeks of worsening right-sided hemichorea in the setting of acute kidney injury and uremia. Head CT was unremarkable. Head MRI showed left putaminal hyperintensity (T1-weighted sequence) and bilateral striatal microhemorrhages (SWAN sequence). She was started on haloperidol with modest improvement of hemichorea. Valproic acid did not provide additional benefit.

Conclusion: The phenotypic spectrum of abnormal movements in diabetic striatopathy ranges from asymptomatic to bilateral hyperkinetic movements that do not respond to glycemic optimization or medications. Concomitant neuroimaging findings are varied and possibly reflect the timing of the study, the range of pathophysiological abnormalities, and individual characteristics of affected patients. Larger case-control or cohort studies will further characterize the clinical, laboratory, and neuroimaging spectrum of diabetic striatopathy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/expanding-the-phenotypic-spectrum-of-diabetic-striatopathy-a-case-series/