Diabetic striatopathy in hispanic patients: recognizing a variable yet treatable movement disorder

Carlos A. Díaz-Garza, Department of Neurology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Monterrey, Mexico
Verónica I. López-Díaz, Department of Neurology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Monterrey, Mexico
Leticia A. Santoyo-Fexas, Department of Neurology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Monterrey, Mexico
Francisco A. Luna-Rangel, Department of Neurology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Monterrey, Mexico
Daniel Martinez-Ramirez, Department of Neurology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Monterrey, Mexico

The objective of the study was to describe the clinical characteristics, diagnostic challenges, and treatment responses of diabetic striatopathy (DS) in Latin American patients, a population with limited reported cases. We conducted a case series of two Latin American women with poorly controlled Type 2 diabetes who developed hyperkinetic movement disorders. Clinical presentations were documented, and neuroimaging was used to confirm DS diagnosis. Treatments and outcomes were analyzed. The first patient, aged 62, presented with acute-onset continuous involuntary movements in the left upper limb, accompanied by pain and hypoesthesia. Computed tomography (CT) showed right-sided striatal hyperdensity, and magnetic resonance imaging revealed T1 hyperintensity. Insulin therapy led to rapid glycemic correction and complete resolution within 48 h. The second patient, aged 70, experienced episodic, progressively worsening involuntary movements of the right upper and lower limbs. Initially misdiagnosed with epilepsy, her symptoms persisted despite antiepileptic treatment. CT revealed a hyperdense lesion in the left basal ganglia, confirming DS. Insulin therapy resulted in partial glycemic improvement, and adjunctive haloperidol provided moderate symptomatic relief, though residual movements persisted at discharge. These cases highlight the heterogeneity of DS presentations in Latin American patients, from acute focal chorea with sensory symptoms to chronic, progressive hyperkinetic syndromes. They underscore the essential role of neuroimaging in establishing a definitive diagnosis and differentiating DS from stroke or seizure disorders. The differing treatment responses reflect the complexity of the underlying pathophysiology and support the need for individualized therapeutic strategies. DS should be considered in the differential diagnosis of new-onset hyperkinetic movement disorders in patients with poorly controlled diabetes.

Keywords: Diabetes. Hyperglycemia. Chorea. Basal ganglia. Case report.