Delayed Presentation of Hemichorea in Diabetic Striatopathy

Diabetic striatopathy is a rare condition associated with poorly controlled diabetes that can present as hyperkinetic movements. A 70-year-old Asian female was newly diagnosed with type 2 diabetes mellitus complicated by diabetic ketoacidosis when she presented with lethargy and confusion. Computed tomography and magnetic resonance imaging of the brain performed for the patient showed incidental isolated radiological features of diabetic striatopathy, even though she did not have any hyperkinetic movements. After intensive glycemic control, the patient paradoxically developed a delayed presentation of hemichorea two weeks later. Pathological findings in diabetic striatopathy suggest the contributing role of vascular microangiopathy, similar to the changes seen in proliferative diabetic retinopathy. In order to avoid precipitating hyperkinetic movements, a less intensive diabetic control could be considered for asymptomatic patients with isolated radiological features of diabetic striatopathy. This is especially important in patients at higher risk of the condition.