Treatment-resistant diabetic chorea manifesting with psychiatric symptoms: a case report

• Published in: Neurocase Vol. 28; no. 5; pp. 432 - 438
• Main Authors: Miyauchi, Tsubasa, Yoshii, Masami, Oshima, Takeo, Tomotsune, Ken, Tomiyasu, Kazuhiro
• Format: Journal Article
• Language: English
• Published: England Routledge 01.10.2022; Taylor & Francis Ltd
• Subjects: Aged; Benzodiazepines; Case reports; Chorea; Chorea - diagnostic imaging; Chorea - drug therapy; Chorea - etiology; Computed tomography; Corpus Striatum - metabolism; Diabetes mellitus; Diabetes Mellitus - metabolism; diabetic striatopathy; Dopamine D2 receptors; Dopamine transporter; Dyskinesia; Haloperidol; Humans; Ischemia; Male; Movement disorder; Neostriatum; neuropsychiatric symptoms; organic modd disorder; Receptor mechanisms; Single photon emission computed tomography; Tiapride Hydrochloride; Tomography, Emission-Computed, Single-Photon - adverse effects; chorea; organic modd disorder; diabetic striatopathy; neuropsychiatric symptoms; Movement disorder
• ISSN: 1355-4794; 1465-3656; 1362-4970
• DOI: 10.1080/13554794.2022.2145906

We report a case of a 69-year-old man with treatment-resistant diabetic chorea presenting psychiatric symptoms. The right chorea lasted for 3 months and was refractory to control of diabetes mellitus or administration of haloperidol and benzodiazepines. Only administration of tiapride was efficacious. Magnetic resonance spectrometry and dopamine transporter-single photon emission computed tomography suggested that sustained ischemia at the striatum may lead to impaired expression of dopamine transporters, thereby resulting in deterioration in the indirect pathway. Tiapride inhibited dopamine D2 receptors, thereby restoring the function of the indirect pathway and resulting in improvement of diabetic chorea.