Diabetic Striatopathy: A Rare Presentation of Nonketotic Hyperglycemia

Abstract

Type II Diabetes Mellitus is one of the most common non-communicable diseases with innumerable & potentially life threatening complications. In 2017, approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world's population (4.4% of those aged 15-49 years, 15% of those aged 50-69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030, reecting a continued rise across all regions of the world.[¹] . Two of the common complications due to acute hyperglycaemia are Diabetic Ketocidosis & Non ketotic hyperosmolar coma which are considered a spectrum of the same complication due to low circulating levels of insulin leading to impaired glucose metabolism by insulin dependant tissues with rising levels of anti-insulin hormones like glucagon, cortisol & catecholamines due to intracellular starvation resulting in hypergylcemia & fatty acid breakdown & ketonemia. Amongst the numerous complications of Type II Diabetes Mellitus, here we present a rare complication of acute hyperglycaemia and its radiological picture in the central nervous system. A 56 year old female patient with a history of Type II Diabetes Mellitus with Hypertension under long term medication came for a private consultation with a complaint of Right sided involuntary, random, irregular, inging and ailing, rapid, non-patterned movements for past 7 days. The patient was advised for an urgent MRI of Brain which demonstrated high T1 signal & low T2/FLAIR intensity with no diffusion restriction of DWI & ADC map in left sided putamen & head of caudate nucleus. We illustrated a rare classical nding of acute hyperglycemic effect on brain in a case of long standing Type II Diabetes Mellitus despite being on medications