A Peculiar Diabetic Striatopathy: A Case Report with Normal Basal Ganglia Imaging

Diabetic striatopathy is a rare entity typically associated with signal changes on brain magnetic resonance imaging (MRI) at the level of the basal ganglia. We report a case of a 67-year-old woman with a history of type 2 diabetes mellitus who presented to the emergency department due to the acute onset of hemiballistic movements. The laboratory work-up revealed hyperglycemia without ketoacidosis. A brain MRI (3T) revealed no anomalies in the basal ganglia. Symptomatic treatment and correction of glucose levels led to a favorable outcome. We assumed a presumptive diagnosis of diabetic striatopathy. We hypothesize that the absence of radiological lesions in the basal ganglia could be due to micro-hemorrhages or ischemic lesions below the detection threshold. In an appropriate clinical context, the lack of clinical-radiological concordance should not prevent the diagnosis of diabetic striatopathy.