SAT-586 Diabetic Striatopathy: A Rare Presentation of Non-ketotic Hyperglycemia

Abstract Disclosure: B. Marquez: None. L. Miranda: None. A. Thomas: None. M. Toustsoglou: None. D. Del Sol: None. Diabetic striatopathy is a rare hyperkinetic movement disorder associated with poorly controlled diabetes, typically in a non-ketotic hyperglycemic state, resulting in damage to the striatum. It presents with a triad of poorly controlled diabetes, unilateral hemichorea or hemiballismus, and contralateral striatal hyperdensity on neuroimaging. Due to its presentation, it can mimic conditions like striatal hemorrhage or infarction, which often leads to misdiagnosis. Early and thorough clinical evaluation is essential for proper diagnosis and management.A 57-year-old woman with a history of poorly controlled diabetes, hypertension, HIV, anxiety, and depression presented with a 3-week history of involuntary movements, initially affecting her right upper extremity and later progressing to both upper and lower right extremities. Symptoms were absent during sleep. She had poor adherence to her diabetes treatment. Her blood pressure was mildly elevated (141/90 mmHg), and physical examination revealed dyskinesias and impaired coordination on motor tests. Laboratory results showed a blood glucose level of 440 mg/dL (70-99 mg/dL), serum creatinine of 1.6 (0.6 to 1.1 mg/dL), and hemoglobin A1c > 14.5% (less than 5.7%), with no signs of diabetic ketoacidosis. Brain MRI revealed hyperintense T1 signals in the left putamen and caudate head, consistent with diabetic striatopathy.She was started on insulin therapy and lorazepam for symptom relief. Glycemic control improved, and symptoms subsided. However, a relapse occurred during follow-up due to poor adherence to insulin, prompting the addition of risperidone 0.5 mg twice daily.Diabetic striatopathy is the second most common cause of hemichorea/hemiballism. While its exact pathophysiology is not fully understood, evidence suggests that striatal damage occurs due to hypoxic injury and cytotoxic edema, which result from hyperglycemia-induced hyperviscosity and a subsequent depletion of inhibitory GABA transmitters.The condition can severely impact daily life, increasing healthcare resource utilization. Further research is needed to improve early detection and develop treatment guidelines. Identifying early biomarkers of brain dysfunction in diabetes could enable earlier interventions and reduce the long-term impact on brain health. Presentation: Saturday, July 12, 2025