An Official publication of The Asian Congress of Neurological Surgeons (AsianCNS)

Search Article
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Advertise Subscribe Contacts Login  Facebook Tweeter
  Users Online: 947 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

   Table of Contents      
LETTER TO EDITOR
Year : 2016  |  Volume : 11  |  Issue : 2  |  Page : 169

Bilateral diabetic striatopathy


1 Department of Radiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
2 P. D. Hinduja Hospital, Mahim, Mumbai, Maharashtra, India

Date of Web Publication1-Mar-2016

Correspondence Address:
Dr. Ashlesha Satish Udare
301, Sakar CHS, Sector 9A, Vashi, Navi Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1793-5482.145105

Rights and Permissions

How to cite this article:
Udare AS, Sankhe S, Mondel PK. Bilateral diabetic striatopathy. Asian J Neurosurg 2016;11:169

How to cite this URL:
Udare AS, Sankhe S, Mondel PK. Bilateral diabetic striatopathy. Asian J Neurosurg [serial online] 2016 [cited 2020 Aug 7];11:169. Available from: http://www.asianjns.org/text.asp?2016/11/2/169/145105

Sir,

A 79-year-old man with a history of type 2 diabetes mellitus (DM) presented with altered sensorium and bilateral chorea-ballismus. Neurological examination was otherwise unremarkable. The blood sugar level during fasting was 540 mg/dL and serum osmolarity was 360mOsm/L with absent ketones. Plain Computed Tomography (CT) scan of the brain revealed bilateral hyperdense basal ganglia [Figure 1]a. Magnetic Resonance Imaging (MRI) revealed hyperintensity in both the basal ganglia on T1W and T2W images [Figure 1]b and [Figure 1]c. An area of hypointensity in the left globus pallidus corresponded to petechial hemorrhage on the gradient sequence [Figure 1]d. The chorea resolved within 2 days of euglycemia on insulin therapy. On 6 months of follow-up, MR images showed decreased signal intensity in both the basal ganglia.
Figure 1: Axial plain CT scan of the brain shows bilateral hyperdense basal ganglia (left > right). (a) Axial T2- and T1-weighted MRI images; (b and c, respectively) Reveal increased signal intensity in the basal ganglia bilaterally. An area of decreased signal intensity seen in the left globus pallidus on T2W and GRE (gradient echo sequence) (d) Images corresponds to petechial hemorrhages

Click here to view


The term “diabetic striatopathy” is characterized by the presence of a high signal on MRI confined to the striatum with contralateral movement disorder. It is commonly associated with type 2 DM and rarely seen in type 1 DM. Most patients at presentation have a clinical picture consistent with a diagnosis of non-ketotic hyperglycemia [1]. Rarely, patients have bilateral lesions with bilateral chorea. Although the actual pathophysiology is unknown, the underlying chronic focal cerebrovascular disease in DM may be responsible for an acute blood–brain barrier dysfunction. Moreover, the decrease in striatal blood flow causes depletion of gamma-aminobutyric acid (GABA) with resultant dyskinesia [2]. Striatal hyperintensity on CT and MRI images in the acute stage of non-ketotic hyperglycemia helps in the early diagnosis and initiation of treatment [3]. The chorea-ballismus is completely reversible. Neuroimaging findings may return to normal or persist after clinical recovery [4].

 
  References Top

1.
Abe Y, Yamamoto T, Soeda T, Kumagai T, Tanno Y, Kubo J, et al. Diabetic striatal disease: clinical presentation, neuroimaging, and pathology. Intern Med 2009;48:1135-41.  Back to cited text no. 1
    
2.
Lai PH, Tien RD, Chang MH, Teng MM, Yang CF, Pan HB, et al. Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. AJNR Am J Neuroradiol 1996;17:1057-64.  Back to cited text no. 2
    
3.
Lin JJ, Lin GY, Shih C, Shen WC. Presentation of striatal hyperintensity on T1-weighted MRI in patients with hemiballism-hemichorea caused by non-ketotic hyperglycemia: Report of seven new cases and a review of literature. J Neurol 2001;248:750-5.  Back to cited text no. 3
    
4.
Battisti C, Forte F, Rubenni E, Dotti MT, Bartali A, Gennari P, et al. Two cases of hemichorea-hemiballism with nonketotic hyperglycemia: A new point of view. Neurol Sci 2009;30:179-83.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
<
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed1645    
    Printed37    
    Emailed0    
    PDF Downloaded128    
    Comments [Add]    

Recommend this journal