MON-137 A Case of Diabetic Striatopathy Initially Diagnosed as Intracerebral Hemorrhage

Diabetic striatopathy is a rare neurologic complication of uncontrolled diabetes, specifically associated with non-ketotic hyperglycemia. Though the exact pathophysiology is unclear, patients with this syndrome typically present with hemichorea-hemiballismus, but other sensorimotor disturbances may also be present. The diagnosis is made through unique radiographic findings on imaging of the basal ganglia, which may be misconstrued as an alternative diagnosis. The following is a case of diabetic striatopathy in patient with uncontrolled diabetes who was initially thought to have an intracerebral hemorrhage (ICH). A 45-year-old gentleman with a prior history of uncontrolled type 2 diabetes mellitus due to non-compliance, hypertension, and hyperlipidemia presented to the emergency department of an outside hospital with the chief complaint of left arm numbness and weakness, as well as left-sided tinnitus, for one week. His physical exam was significant for lateral strabismus of the left eye. His blood work on evaluation revealed profound hyperglycemia of 700 mg/dL. A computerized topography (CT) scan of the head revealed enhancement of the right basal ganglia. Due to initial concern for an ICH, he was subsequently transferred to a tertiary care center for further evaluation. However, upon a second review of imaging by radiology and neurology, it was determined that this was less likely to be an ICH given his otherwise normal neurologic exam. There was additionally no vasogenic edema on the CT scan. Given his profound hyperglycemia and his symptoms, the working diagnosis of diabetic striatopathy was established. With correction of his blood sugars, his symptoms improved and on follow-up magnetic resonance imaging (MRI) of the brain, his initial basal ganglia enhancement had resolved. This case highlights a rare but significant complication of hyperglycemia that is important to diagnose early to prevent possible permanent structural change and continuous symptoms. This syndrome should especially be considered in diabetic patients with hyperglycemia and abnormal findings on neuroimaging, to facilitate timely treatment via correction of hyperglycemia which can lead to resolution of symptoms.