Acute onset movement disorders in diabetes mellitus: A clinical series of 59 patients

Abstract

Background and purpose No previous study has assessed the frequency and clinical–radiological characteristics of patients with diabetes mellitus (DM) and acute onset nonchoreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM. Methods We recruited all the patients with acute onset movement disorders and hyperglycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021. Results Among the 59 patients (mean age = 55.4 ± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder (n = 18, 30.5%), followed by pure chorea (n = 15, 25.4%), choreoathetosis (n = 8, 13.6%), tremor (n = 5, 8.5%), hemifacial spasm (n = 3, 5.1%), parkinsonism (n = 3, 5.1%), myoclonus (n = 3, 5.1%), dystonia (n = 2, 3.4%), and restless leg syndrome (n = 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hyperglycemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely. Conclusions This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status.

Clinical and imaging features of diabetic striatopathy: report of 6 cases and literature review

“…Among them, small vessel disease was characterized by obliteration of small artery lumen, strikingly thickening of all three layers of the wall, hyaline change, and remarkable proliferation of small blood vessels, which were similar to diabetic retinopathy. In this study, patient 2 had diabetic retinopathy and diabetic nephropathy, combined with previous studies [ 18 , 28 ], showed that there was correlation between striatal lesions and microangiopathy. ⑵ Infection and autoimmune inflammatory response theory.…”

“…Non-ketotic hyperglycemia, unilateral limb choreographic dyskinesia, and striatal abnormalities on neuroimaging are typical signs of DS. Previous studies have found that chorea associated with hyperglycemia occurs mostly unilaterally and rarely bilaterally; a few may occur in hypoglycemic states or after correction of hyperglycemia [ 1 , 16 – 18 ], and a few DS cases reported no chorea [ 18 – 20 ] or had nonchoreic and nonballistic movements [ 7 , 12 , 14 , 18 , 21 , 22 ]. The imaging manifestation may also be unremarkable [ 16 , 18 , 23 ].…”

“…Previous studies have found that chorea associated with hyperglycemia occurs mostly unilaterally and rarely bilaterally; a few may occur in hypoglycemic states or after correction of hyperglycemia [ 1 , 16 – 18 ], and a few DS cases reported no chorea [ 18 – 20 ] or had nonchoreic and nonballistic movements [ 7 , 12 , 14 , 18 , 21 , 22 ]. The imaging manifestation may also be unremarkable [ 16 , 18 , 23 ]. Dubey et al [ 18 ] studied 59 diabetic patients with acute dyskinesia and found that 44.1% of the patients had abnormal striatal signals, while the majority of the patients (55.9%) did not have abnormal striatal signals, and the proportion of male patients in this study was higher (52.5%), which was different from previous studies.…”

“…The imaging manifestation may also be unremarkable [ 16 , 18 , 23 ]. Dubey et al [ 18 ] studied 59 diabetic patients with acute dyskinesia and found that 44.1% of the patients had abnormal striatal signals, while the majority of the patients (55.9%) did not have abnormal striatal signals, and the proportion of male patients in this study was higher (52.5%), which was different from previous studies. In this study, 41 (69.5%) had choreic or ballistic movements and 18 (30.5%) had nonchoreic or nonballistic movements; the latter include myoclonus, dystoni, facial spasm, restless leg syndrome, tremors, and Parkinsonism.…”

Diabetic Striatopathy Complicated With Acute Ischemic Stroke: A Case Report

“…Diabetic striatopathy (DS) is a rare complication secondary to hyperglycemia, featured by the choreiform movements, and reversible striatal abnormalities in neuroimaging (Chua et al, 2020 ). In recent years, an increasing number of studies have described the clinical characteristics of DS (Kim et al, 2015 ; Yu et al, 2017 ; Wang et al, 2020 ; Zheng et al, 2020 ; Zhao et al, 2021 ; Dubey et al, 2022 ; Tsalta-Mladenov et al, 2022 ). However, the simultaneous occurrence of DS and acute ischemic stroke (AIS) in the striatum has not been reported.…”