Diabetic Striatopathy Complicated by Fatal Laminar Cortical Necrosis: A Case Report

Abstract Background: Diabetic striatopathy (DS), or non-ketotic hyperglycemia-induced hemichorea-hemiballism, is a rare movement disorder that occasionally serves as the initial presentation of previously undiagnosed diabetes. While its course is generally favorable, it can exceptionally be complicated by laminar cortical necrosis (LCN), a formidable and most often fatal condition. Case Presentation: A 60-year-old male with a history of poorly controlled type 2 diabetes was admitted for acute hemichorea-hemiballism associated with severe non-ketotic hyperglycemia of 11 g/L (1100 mg/dL). Brain MRI confirmed diabetic striatopathy involving the basal ganglia. Despite initial improvement under haloperidol and glycemic correction, the patient presented two weeks later with sudden neurological deterioration characterized by behavioral disturbances and hallucinations. Follow-up MRI revealed laminar cortical necrosis, leading to the patient's death within 48 hours. Discussion and Conclusion : This case illustrates an extremely rare and severe clinical association between diabetic striatopathy and laminar cortical necrosis. It highlights that while magnetic resonance imaging (MRI) is essential for early diagnosis and monitoring, the onset of this cortical complication turns a typically benign metabolic syndrome into a fatal outcome, emphasizing the need for future multicenter studies to better identify its risk factors.