SUN-612 - Diabetic Striatopathy: An Underrecognized Cause of Acute Unilateral Movement Disorders

Diabetic striatopathy (DS) is a rare neurological complication of poorly controlled diabetes, typically type 2, characterized by sudden involuntary jerking movements due to metabolic and vascular changes in the basal ganglia. These changes are visible as hyperintensities on MRI or CT scans and usually resolve with strict glucose control.
A 60-year-old woman with a history of breast cancer presented to the emergency department with new-onset spasmodic movements of her left arm and a serum glucose level of 664 mg/dL. One week prior, she had been started on metformin for new-onset type 2 diabetes. She had been taking muscle relaxants at home with no improvement.
She was admitted to the hospital and was started on a basal–bolus insulin regimen. She was evaluated by the neurology team. On physical exam, repetitive, stereotyped, jerky, clenching, involuntary movements of the left hand and arm were noted. The remainder of the neurological examination was unremarkable, with no loss of consciousness, progression to other body areas, urinary or fecal incontinence, or tongue biting. MRI of the brain demonstrated hyperintensity of the head of the caudate nucleus, more pronounced on the right side. She was diagnosed with hemichorea–hemiballismus secondary to diabetic striatopathy and treated with haloperidol. Serum glucose levels normalized, and she was discharged home, where she took two additional doses of haloperidol. Her neurological symptoms resolved completely two days after discharge.
Diabetic striatopathy typically presents unilateral involuntary, jerky, or flinging movements. Sudden surges in serum glucose can cause metabolic stress and vascular injury, leading to microscopic changes such as astrocytic swelling, neuronal loss, and small hemorrhages in the basal ganglia, thereby disrupting normal motor control. Neuroimaging with CT or MRI shows hyperintensity in the basal ganglia, often without contrast enhancement. The condition is more commonly seen in elderly women with type 2 diabetes. Prognosis is excellent, with both symptoms and neuroimaging findings frequently resolving as glucose levels normalize. Treatment consists primarily of strict glycemic control, with dopamine antagonists such as haloperidol providing symptomatic relief.
Diabetic striatopathy is often underdiagnosed and easily mistaken for stroke or seizure disorders, highlighting the importance of evaluating serum glucose levels in patients presenting with new-onset movement disorders.

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