Uncontrolled Diabetes Unmasking Diabetic Striatopathy: A Reversible Cause of Hyperkinetic Movement Disorder

Diabetic striatopathy (DS) is a rare neurological complication of non-ketotic hyperglycemia. It is distinguished by the acute onset of hemichorea and hemiballismus, as well as distinct radiographic findings involving the contralateral basal ganglia. We present the case of a 61-year-old male patient with a history of poorly controlled diabetes mellitus who developed acute involuntary movements affecting the right upper and lower extremities. Computed tomography (CT) revealed a hyperdensity in the left basal ganglia, and T1 hyperintensity with mild diffusion-weighted imaging hyperintensities on MRI, consistent with DS. Patient history and laboratory analysis revealed diabetic medication non-compliance and a glycosylated hemoglobin (HbA1c) of 14% and a blood glucose level of 472 mg/dL, without evidence of ketosis. The patient was treated with insulin therapy, resulting in proper glycemic control and complete resolution of symptoms. This case underscores the importance of recognizing DS in patients with hyperglycemia and acute movement disorders, as timely diagnosis and metabolic correction can lead to full neurological recovery and prevent unnecessary interventions.