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Easily missed or misinterpreted: diabetic striatopathy in the course of ketotic hyperglycaemia
  1. Katarzyna Markowska1,
  2. Ewa Koziorowska-Gawron1,
  3. Paulina Papier1,
  4. Magdalena Koszewicz1,
  5. Sławomir Budrewicz1,
  6. Joanna Bladowska2,
  7. Anna Zimny2
  1. 1 Neurology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
  2. 2 General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
  1. Correspondence to Dr Ewa Koziorowska-Gawron, Neurology, Wroclaw Medical University, Wroclaw 50-367, Poland; ewakozi{at}vp.pl

http://dx.doi.org/10.1136/postgradmedj-2020-139499

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    A 61-year-old man suffering from diabetes mellitus type 2 (DM2) for 10 years and a 67-year-old woman with no medical history developed subacutely unilateral involuntary movements. The former patient demonstrated moderate hemichorea-hemiballism (HC-HB) in the left limbs for 3 weeks, while the latter patient presented mild hemichorea in the right upper limb for 1 week (online supplemental video showing symptoms of the second patient). Laboratory tests revealed hyperglycaemia (random blood glucose levels: 470 mg/dL and 560 mg/dL, respectively) and elevated glycosylated haemoglobin A1c levels (15.4% and 13.1%, respectively) with positive urine ketones and normal blood gas analysis. Both brain CT and MRI showed lesions in the striatum contralateral …

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    Footnotes

    • Contributors KM, EK-G, PP, MK and SB contributed to the patients’ care, the collection of the study data and drafting the manuscript. AZ and JB provided neuroimaging examinations and figures and contributed to the writing of the radiological part of the manuscript. All authors contributed to the study conception, critically revised the manuscript and approved the submitted version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.