Ipsilateral diabetic striatopathy: A case of clinicoradiological discordance and evolving movement disorders

TL;DR

A rare case of diabetic striatopathy shows mismatch between symptoms and brain imaging, with movement issues not aligning with the location of brain lesions.

Contribution

This case report highlights a rare clinicoradiological discordance in diabetic striatopathy with ipsilateral striatal lesions.

Findings

The patient showed right-sided movement disorders with a right-sided striatal lesion on imaging.

Symptoms only partially improved despite glycemic control and medication.

New perioral dyskinesias emerged during follow-up, indicating evolving neurological changes.

Abstract

Diabetic striatopathy (DS) typically presents with hemichoreoballism and contralateral striatal lesions on neuroimaging. However, cases of unilateral movement disorders with predominant ipsilateral striatal lesions are rare.

We present a case of DS in a 62-year-old woman from rural India with poorly controlled diabetes mellitus who developed acute-onset right hemichoreoballism. Neuroimaging revealed a predominantly right-sided striatal lesion, illustrating a clinicoradiological discordance—a mismatch between the clinical symptoms and radiological findings. Despite achieving tight glycemic control and administering neuroleptic medications, the involuntary movements demonstrated only partial improvement. Neurological changes persisted on the ipsilateral side of the affected limbs even after 1 year of follow-up. Notably, perioral dyskinesias developed during subsequent follow-up visits.

This report highlights the clinical and neuroradiological discordance observed in DS. The potential underlying mechanisms contributing to this paradox are explored and discussed.

The clinical and radiological discordance in DS is a frequent yet under-reported phenomenon. However, the actual mechanistic underpinnings need to be addressed by advanced functional and structural neuroimaging.

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