Teaching NeuroImage: Basal Ganglia T1 Hyperintensity and SWI Signal Diabetic Striatopathy in an 18-Year-Old Man With Type 1 Diabetes Mellitus

An 18-year-old man with type 1 diabetes presented with acute bilateral arm and leg ballismus and oral-buccal dyskinesia. Glucose was 394 and HgbA1c >14. Imaging revealed T1 hyperintensity and susceptibility effect within the basal ganglia (Figure). Symptoms resolved over 48 hours with glucose control. A diagnosis of diabetic striatopathy was made. Diabetic striatopathy, also called hyperglycemic hemiballism/hemichorea, is most often described in older individuals with type 2 diabetes. Clinical symptoms often resolve with glycemic control; however, many patients require pharmacologic treatments. Deep brain stimulation may be beneficial in cases with disabling involuntary movements. Hyperglycemia-induced vasculopathy may contribute to microhemorrhages on imaging.1,2

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