Diabetic Striatopathy as a Presenting Symptom in Newly Diagnosed Type 2 Diabetes Mellitus

Diabetic striatopathy is a rare, acute neurological complication of diabetes mellitus which presents with non-ketotic hyperglycemia and involuntary movements, specifically hemichorea or hemiballismus. Striatal abnormalities on neuroimaging have been reported in most, but not all cases. This case report aims to increase awareness that diabetic striatopathy can be a presenting symptom of diabetes mellitus. A 92-year-old Filipino female with no history of diabetes presented with acute onset of focal clonic flexion of the left upper extremity for a few hours, which progressed to right hemifacial spasm. She was diagnosed with a hyperosmolar hyperglycemic state and was treated accordingly. Cranial CT scan findings were unremarkable. There was an immediate resolution of her neurologic symptoms after the correction of hyperglycemia. The diagnosis of diabetic striatopathy highlights the importance of increasing awareness and understanding of this condition among clinicians to prevent delayed diagnosis and treatment. Screening for hyperglycemia is advisable for patients with involuntary movements. The prognosis for diabetic striatopathy is good with prompt glycemic control in most cases.