SUN-615 Diabetic Striatopathy Presenting With Hemiballism: An Unusual Neurologic Complication Of Uncontrolled Type 2 Diabetes Mellitus

Abstract Disclosure: J. Tatchou: None. B. Jesus: None. M. Hassan: None. B. Rebba: None. Introduction: Hemiballism is a rare movement disorder, most commonly associated with stroke. We describe a case of Diabetic Striatopathy presenting with a 1-week history of hemiballism movements in the setting of uncontrolled Type 2 Diabetes Mellitus. Case Presentation: A 77-year-old lady with hypertension, uncontrolled Type 2 Diabetes Mellitus on insulin therapy, HIV disease, and hyperlipidemia presented with a 1-week history of worsening painful, wild, involuntary muscle spasms of her left upper extremity. She endorsed a 1-day history of decreased appetite, abdominal pain, nausea, and vomiting. She denied fever, headache, focal weakness, or numbness. She did not report a recent change in medications. She is on aspirin 81 mg daily, atorvastatin 40 mg daily, carvedilol 25mg twice daily, chlorthalidone 50 mg daily, spironolactone 100 mg daily, losartan 50 mg daily and the combination of elvitegravir- cobicistat- emtricitabine-tenofovir alafenamide as 1 tablet daily.Physical exam showed dry mucous membranes, tachycardia, intermittent left upper extremity abduction and adduction movements, with no other motor or sensory deficits. CT brain ruled out intracranial hemorrhage. MRI of the brain showed no structural abnormalities.Serum creatinine was 1.75 mg/dl (n= 0.5-1.60mg/dl) (unknown baseline), BUN 37 mg/dl (n= 8-23 mg/dl), potassium 5.4 mmol/l(n=3.3-5.1mmol/l), glucose 84 mg/dl (n=82-115 mg/dl), and creatinine kinase 2388 iU/l (n=9-168 iU/l). HIV viral load was undetectable. She received IV fluids, and her kidney function improved to the normal range.During hospitalization, she was noted to have a fluctuating blood glucose level, ranging from 80 mg/dl to 370 mg/dl. Hemoglobin A1c was 14%. She was started on an adequate insulin regimen and clonazepam 0.25 mg three times daily. Hemiballism movements strikingly improved with control of glucose level and were concluded to be due to uncontrolled diabetes. At the time of discharge, she continued to show significant improvement in her involuntary movements. Conclusion: Diabetic striatopathy is a rare neurologic complication of uncontrolled hyperglycemia, characterized by abnormal movement (hemichorea/ hemiballism). The most common radiologic finding is hyperdensity in the contralateral putamen and/or caudate nucleus on CT scan. Management relies on the correction of hyperglycemia and the administration of antipsychotics (haloperidol, risperidone) or benzodiazepines(clonazepam). Presentation: Sunday, July 13, 2025