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Abstract Details

Diabetic Striatopathy, a rare complication of uncontrolled diabetes: A review of distinct clinical presentations of three different cases
Neuro Trauma and Critical Care
P12 - Poster Session 12 (5:30 PM-6:30 PM)
Diabetic Striatopathy (DS) is an uncommon neurological presentation of diabetes mellitus, characterized by abnormal movements, mainly hemichorea and hemiballismus. It manifests in patients with poor glycemic control and is usually associated with hyperglycemic hyperosmolar state or DKA. 
Case presentation

A 50 year old male with history of type 2 diabetes mellitus (DM), baseline left-sided hemiparesis, presented with worsening left sided weakness in the setting of DKA. CT head revealed well delineated right basal ganglia hyperdensity, initially thought to be a hemorrhage. MRI brain revealed T1 hyperintensity in right basal ganglia, suspicious for DS. Patient presented as stroke mimic and no abnormal movements were reported.

A 78 year old female with history of type 2 DM presented after a fall. She had three weeks of abnormal movements in her right arm and right leg, causing multiple falls. Labs revealed HbA1c >18. Video EEG didn’t capture any abnormal right sided movements. CT head showed hyperintensity in the left basal ganglia. MRI brain showed increased T1 signal within the left basal ganglia consistent with DS. No further abnormal movements were reported after strict glycemic control.

A 73 year female with history of type 2 DM, presented with confusion and facial asymmetry. Lab revealed HbA1c of 16.1 and she was in DKA. CT head showed hyperintensity in the right basal ganglia. MRI brain showed increased T1 signal within the right basal ganglia consistent with DS. MRI also revealed multiple embolic strokes. Although this patient had radiographic findings consistent with DS, there were no abnormal movements reported. 

DS is an uncommon and poorly understood complication of DM. It can rarely present as stroke or seizure mimic. Radiographic findings are often mistaken as hemorrhage. DS should be considered as a diagnosis of high suspicion in patients with uncontrolled diabetes and abnormal basal ganglia imaging.
Navreet Kaur, MBBS (Boston University Medical Center)
Dr. Kaur has nothing to disclose.
Kehan Zhao, MD (SUNY Upstate Medical University) Dr. Zhao has nothing to disclose.
Rashid A. Ahmed, MD (Upstate University Hospital) Dr. Ahmed has nothing to disclose.
Julius Latorre, MD, FAAN (SUNY Upstate Med Univ Hosp/Neuro) Dr. Latorre has nothing to disclose.
Elena Schmidt, MD Dr. Schmidt has nothing to disclose.