Diabetic striatopathy-Does it exist in non-Asian subjects?

Area of Science:

• Neurology
• Endocrinology
• Medical Imaging

Background:

• Diabetic striatopathy (DS) is a rare complication of diabetes mellitus (DM), typically affecting elderly women with uncontrolled DM.
• The syndrome is characterized by abrupt onset movement disorders, primarily hemichorea, and distinctive brain imaging findings.
• DS was previously thought to be unique to the Asian population.

Purpose of the Study:

• To investigate the existence and characteristics of diabetic striatopathy in a Western population.
• To evaluate the diagnostic challenges and clinical presentation of DS in non-Asian patients.

Main Methods:

• Retrospective review of medical records of patients with elevated HbA1c (>10%) at Chaim Sheba Medical Center (2004-2014).
• Identification and detailed analysis of patients with undiagnosed neurological symptoms and imaging findings consistent with DS.
• Case series analysis of identified patients.

Main Results:

• Four cases of DS were identified among 697 patients with HbA1c >10% and unknown neurological diagnosis.
• The affected patients were elderly women with a mean HbA1c of 14.8% and presented with hemichorea or choreoathetosis.
• Only one patient was diagnosed during hospitalization; symptoms improved with insulin, but recurrence and mortality were observed.

Conclusions:

• Diabetic striatopathy is present but underdiagnosed in the Western population.
• Enhanced clinical awareness is necessary for timely diagnosis and appropriate management of DS.
• This study highlights the need to consider DS in Western patients presenting with unexplained movement disorders and uncontrolled diabetes.