When Hyperglycemia Moves the Body: A Case of Diabetic Striatopathy

Diabetic striatopathy (DS) is a rare but distinctive neurological manifestation of poorly controlled diabetes mellitus, characterized by the onset of involuntary movements, commonly hemichorea or hemiballismus, and distinctive basal ganglia abnormalities on neuroimaging in the setting of hyperglycemia. Pathophysiology is still not fully understood. Prognosis is usually favorable with glycemic control. We present a case of a 71-year-old Asian man with uncontrolled type 2 diabetes who developed progressive right-sided hemichorea-hemiballismus over three weeks. Initial neuroimaging was misinterpreted, delaying diagnosis. Upon re-evaluation, hallmark findings were recognized, including unilateral putaminal hyperdensity on computed tomography (CT) and corresponding T1-weighted hyperintensity on magnetic resonance imaging (MRI). The patient demonstrated significant improvement following glycemic optimization and neuroleptic therapy. This case highlights the importance of recognizing the characteristic clinico-radiologic features of DS to ensure a timely diagnosis and initiation of appropriate therapy, which typically leads to an excellent prognosis.