1887
Volume 2025, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Diabetic striatopathy (DS) typically presents with hemichoreoballism and contralateral striatal lesions on neuroimaging. However, cases of unilateral movement disorders with predominant ipsilateral striatal lesions are rare.

We present a case of DS in a 62-year-old woman from rural India with poorly controlled diabetes mellitus who developed acute-onset right hemichoreoballism. Neuroimaging revealed a predominantly right-sided striatal lesion, illustrating a clinicoradiological discordance—a mismatch between the clinical symptoms and radiological findings. Despite achieving tight glycemic control and administering neuroleptic medications, the involuntary movements demonstrated only partial improvement. Neurological changes persisted on the ipsilateral side of the affected limbs even after 1 year of follow-up. Notably, perioral dyskinesias developed during subsequent follow-up visits.

This report highlights the clinical and neuroradiological discordance observed in DS. The potential underlying mechanisms contributing to this paradox are explored and discussed.

The clinical and radiological discordance in DS is a frequent yet under-reported phenomenon. However, the actual mechanistic underpinnings need to be addressed by advanced functional and structural neuroimaging.

© 2025 Chatterjee, Biswas, Sengupta, Das, Ghosh, Bhattacharjee, et al., licensee HBKU Press.
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2025-06-09
2025-07-17
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References

  1. Chatterjee S, Ghosh R, Biswas P, Das S, Sengupta S, Dubey S, et al.. Diabetic striatopathy and other acute onset de novo movement disorders in hyperglycemia. Diabetes Metab Syndr. 2024; 18:102997.
    [Google Scholar]
  2. Chua CB, Sun CK, Hsu CW, Tai YC, Liang CY, Tsai IT. “Diabetic striatopathy”: clinical presentations, controversy, pathogenesis, treatments, and outcomes. Sci Rep. 2020; 10:1594.
    [Google Scholar]
  3. Mukherjee D, Chatterjee S, Sarkar P, Ghosh R, Das S, Ray BK, et al.. Expanding the spectrum of diabetic striatopathy: insights from a case of hyperglycemia-induced propriospinal myoclonus. Tremor Other Hyperkinet Mov (N Y). 2023; 13:50.
    [Google Scholar]
  4. Dubey S, Chatterjee S, Ghosh R, Louis ED, Hazra A, Sengupta S, et al.. Acute onset movement disorders in diabetes mellitus: a clinical series of 59 patients. Eur J Neurol. 2022; 29:2241–8.
    [Google Scholar]
  5. Dubey S, Biswas P, Ghosh R, Chatterjee S, Kanti Ray B, Benito-León J. Neuroimaging of diabetic striatopathy: more questions than answers. Eur Neurol. 2022; 85:371–6.
    [Google Scholar]
  6. Chatterjee S, Ghosh R, Dubey S. Diabetic striatopathy. 2023 Aug 1. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., (editors). Endotext. South Dartmouth (MA):MDText.com, Inc. ; 2000.
    [Google Scholar]
  7. Lin JJ. Ipsilateral putamen hyperintensity on T1-weighted MRI in non-ketotic hyperglycemia with hemiballism-hemichorea: a case report. Parkinsonism Relat Disord. 2001; 7:319–21.
    [Google Scholar]
  8. Fong SL, Tan AH, Lau KF, Ramli N, Lim SY. Hyperglycemia-associated hemichorea-hemiballismus with predominant ipsilateral putaminal abnormality on neuroimaging. J Mov Disord. 2019; 12:187–9.
    [Google Scholar]
  9. Zhou LW, Chew J, Field TS. Teaching neuroimages: stroke with nondecussating corticospinal tracts causing ipsilateral weakness: straight forward. Neurology. 2021; 96:e480–1.
    [Google Scholar]
  10. Kannepalli NR, Yadav R, Vazhayil V, Somanna S, Pal PK. Ipsilateral hemichorea-hemiballism in a case of postoperative stroke. Tremor Other Hyperkinet Mov (N Y). 2016; 6:359.
    [Google Scholar]
  11. Alberts JL, Hass CJ, Vitek JL, Okun MS. Are two leads always better than one: an emerging case for unilateral subthalamic deep brain stimulation in Parkinson’s disease. Exp Neurol. 2008; 214:1–5.
    [Google Scholar]
  12. Slevin JT, Gerhardt GA, Smith CD, Gash DM, Kryscio R, Young B. Improvement of bilateral motor functions in patients with Parkinson disease through the unilateral intraputaminal infusion of glial cell line-derived neurotrophic factor. J Neurosurg. 2005; 102:216–22.
    [Google Scholar]
  13. Shemisa K, Hass CJ, Foote KD, Okun MS, Wu SS, Jacobson CE 4th, et al.. Unilateral deep brain stimulation surgery in Parkinson’s disease improves ipsilateral symptoms regardless of laterality. Parkinsonism Relat Disord. 2011; 17:745–8.
    [Google Scholar]
  14. Lin YT, Chen SC, Yip PK, Wang V. Magnetic resonance imaging volumetric analysis for diabetic striatopathy with two episodes of hemichorea-hemiballism syndrome: a case report. Medicine (Baltimore). 2019; 98:e17249.
    [Google Scholar]
  15. Lucassen EB, Delfyett WT, Stahl MC. Persistent hemichorea and caudate atrophy in untreated diabetic striatopathy: a case report. Case Rep Neurol. 2017; 9:299–303.
    [Google Scholar]
  16. Chatterjee S, Ghosh R, Ojha UK, Diksha , Biswas P, Benito-León J, et al.. Recurrent facial focal seizures with chronic striatopathy and caudate atrophy-A double whammy in an elderly woman with diabetes mellitus. Neurohospitalist. 2022; 12:147–50.
    [Google Scholar]
  17. Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Diabetic striatopathy: an updated overview of current knowledge and future perspectives. J Endocrinol Invest. 2024; 47:1–15.
    [Google Scholar]
  18. Ganzini L, Heintz RT, Hoffman WF, Casey DE. The prevalence of tardive dyskinesia in neuroleptic-treated diabetics. A controlled study. Arch Gen Psychiatry. 1991; 48:259–63.
    [Google Scholar]
/content/journals/10.5339/qmj.2025.60
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Ipsilateral diabetic striatopathy: A case of clinicoradiological discordance and evolving movement disorders
Qatar Medical Journal 2025, 60 (2025); https://doi.org/10.5339/qmj.2025.60
/content/journals/10.5339/qmj.2025.60
/content/journals/10.5339/qmj.2025.60
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  • Article Type: Case Report
Keyword(s): diabetes, Diabetic striatopathy, hemiballism, hemichorea and hyperglycemia

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