Diabetic Striatopathy

Acute onset de novo movement disorders are increasingly being reported in the settings of hyperglycemia, particularly from Asian countries. Although hemichorea-hemiballism is the most common and classically described movement semiology in association with hyperglycemia, various other hyperkinetic (choreoathetosis, dystonia, tremors, akathisia, restless leg syndrome etc.) and hypokinetic (parkinsonism) movement disorders are recognized. Diabetic striatopathy (DS) is defined as the disease phenomenon characterized by either choreo-ballistic movement or suggestive signature changes in striatum on imaging or presence of both. DS is generally considered as the complication of long-standing, poorly controlled non-ketotic hyperglycemia with acute hyperglycemic surge, though it can also be the first presentation of previously undiagnosed diabetes. Thus, it is recommended to test for capillary blood glucose in every patient presenting with de novo acute onset movement disorders of any semiology irrespective of past history of diabetes. It is important to recognize that normal brain imaging does not exclude the diagnosis of DS (clinically isolated DS) because nearly 50% cases may not have any characteristic neuroradiological stigmata. There is also high prevalence of clinical-neuroradiological discordance in DS cases. Thus, while managing such patients’ priority should be imparted on bedside identification of the movement semiology accurately and aggressive treatment of hyperglycemia rather than ordering expensive neuroradiological investigation. Generally diabetic movement disorder carries excellent prognosis. The majority of cases rapidly resolves with insulin therapy alone with or without use of adjunctive neuroleptics. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.