Diabetic striatopathy: a case report

Abstract

Introduction: Striatopathy or non-ketonic hyperglycemia is a rare etiology, but well reported in the literature, of involuntary movements in patients with diabetes mellitus, being characterized by affecting, in general, elderly patients with hemicorrea-hemiballismus. The aim is to report a clinical case of the development of movement disorder caused by hyperglycemia. Case report: Patient E.J.D.O, 71-year-old, male, hypertensive and dyslipidemic. Admitted to the emergency room with a history of involuntary movements in the upper left limb for about two months, with recent worsening. Upon admission, a hyperglycemic state (capillary blood glucose HI) was observed, until then, the patient had not been diagnosed with diabetes. The movements were present at rest, worsened on intention and were present during sleep, being characterized as clonic/myoclonic movements. In view of the clinical picture on admission, the hypothesis of subtle focal status epilepticus was suggested, and therefore Diazepam 2 mg EV was performed as a therapeutic test, with notable improvement of the picture. As a complementary propaedeutic, brain magnetic resonance imaging was performed. An electroencephalogram was also requested, which showed no epileptiform activity in status epilepticus. Cerebrospinal fluid collection was performed, showing possible reduction of diffusion. The patient was discharged after receiving valproic acid and clobazam, however, he returned later, reporting worsening of movements to which he associated the interruption of medications. The hypothesis of autoimmune encephalitis was raised, but no immunosuppressive therapy was instituted. During the second hospitalization, he had complications, including CRA, progressing to a state of hypoxic-ischemic encephalopathy. Conclusion: In this report, we describe a patient with focal involuntary movements who made a differential diagnosis between epileptic seizures/focal status evil with movement disorders of metabolic etiology such as hyperglycemia, with the topographic radiological finding corroborating such differential diagnosis. In the literature, there is a consistent association between movement disorders and hyperglycemia, especially in elderly patients, which adds strength to the present case report. Korea.