Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
Neuro Endocrinol Lett. 2020 Oct;41(4):162-165.
Diabetic striatopathy is a rare condition characterized by unilateral hemichorea and/or hemiballismus in the settings of uncontrolled nonketotic diabetes mellitus. Imaging studies usually reveal striatal abnormality - subtle hyperdensity on CT and T1 hyperintensity on MRI. The resolution of clinical symptoms is prompt when optimal glycaemic control is achieved.
We present the case of a 90-year-old male who came to our attention for acute involuntary choreiform movements of his left-sided extremities lasting two-weeks. Apart from that neurological examination was unremarkable. His medical history included hypertension, atrial fibrillation, previous stroke with no residual disability and poorly controlled type 2 diabetes mellitus on metformin treatment. There was no history of movement disorders or exposure to neuroleptics. His glucose level on admission was 512.6 mg/dL, glycated hemoglobin was 14%. CT scan of the head demonstrated an abnormally increased intensity within the right striatum. Treatment consisted of symptomatic treatment of chorea and improvement of blood glucose control. Tiapride was started with a dose of 100 mg 4 times a day. The patient was initiated on intensive insulin therapy which included insulin glargine 10 units every evening and 12 units of insulin glulisine 3 times a day with meals. Abnormal movements resolved after normoglycemia was achieved approximately 7 days after admission. Though striatal hyperdensity was still present at follow-up CT scan after 10 days, it was less pronounced.
Diabetic striatopathy is a rare but treatable disorder and should be considered in patients with poorly controlled diabetes who present with hemichorea.
糖尿病纹状体病是一种罕见的疾病，其特征是在未经控制的非酮症糖尿病患者中出现单侧舞蹈症和/或偏侧投掷症。影像学研究通常显示纹状体异常 - CT 上的细微高密度和 MRI 上的 T1 高信号。当达到最佳血糖控制时，临床症状迅速缓解。
我们报告了一例 90 岁男性患者，因左侧肢体急性不自主舞蹈样运动持续两周就诊。除了神经系统检查无异常外。他的病史包括高血压、心房颤动、以前的中风无残留残疾和二甲双胍治疗的 2 型糖尿病控制不佳。没有运动障碍或接触神经阻滞剂的病史。入院时血糖水平为 512.6mg/dL，糖化血红蛋白为 14%。头部 CT 扫描显示右纹状体异常增强。治疗包括舞蹈症的对症治疗和改善血糖控制。给予泰必利治疗，起始剂量为 100mg，每日 4 次。患者开始接受强化胰岛素治疗，包括每晚 10 单位甘精胰岛素和每日 3 次随餐给予 12 单位赖脯胰岛素。入院后约 7 天血糖正常后，异常运动得到缓解。尽管在入院后 10 天的随访 CT 扫描中仍然存在纹状体高密度，但程度较轻。
糖尿病纹状体病是一种罕见但可治疗的疾病，对于控制不佳的糖尿病患者出现偏侧舞蹈症，应考虑该病。
