“Diabetic striatopathy”: clinical presentations, controversy, pathogenesis, treatments, and outcomes

• Published in: Scientific reports Vol. 10; no. 1; p. 1594
• Main Authors: Chua, Choon-Bing, Sun, Cheuk-Kwan, Hsu, Chih-Wei, Tai, Yi-Cheng, Liang, Chih-Yu, Tsai, I-Ting
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 31.01.2020; Nature Publishing Group
• Subjects: 692/163; 692/1807; 692/617; Adolescent; Adult; Aged; Aged, 80 and over; Arm; Caudate nucleus; Child; Chorea; Computed tomography; Corpus Striatum - diagnostic imaging; Corpus Striatum - pathology; Diabetes; Diabetes Complications - diagnosis; Diabetes Complications - pathology; Diabetes Complications - therapy; Diabetes mellitus; Diabetes Mellitus, Type 2 - pathology; Female; Glucose; Haloperidol; Hemoglobin; Hemorrhage; Humanities and Social Sciences; Humans; Hyperglycemia; Magnetic Resonance Imaging; Male; Middle Aged; multidisciplinary; Neostriatum; Neuroimaging; Nomenclature; Pathogenesis; Patients; Putamen; Science; Science (multidisciplinary); Tomography, X-Ray Computed; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-58555-w

Diabetic striatopathy (DS) is a rare medical condition with ambiguous nomenclature. We searched PubMed database from 1992 to 2018 for articles describing hyperglycemia associated with chorea/ballism and/or neuroimages of striatal abnormalities. Descriptive analysis was performed on demographic/clinical characteristics, locations of striatal abnormalities on neuroimages, pathology findings, treatment strategies, and outcomes. In total, 176 patients (male:female = 1:1.7) were identified from 72 articles with mean age 67.6 ± 15.9 (range, 8–92). Among them, 96.6% had type 2 DM with 17% being newly diagnosed. Average blood glucose and glycated hemoglobin concentrations were 414 mg/dL and 13.1%, respectively. Most patients (88.1%) presented with hemichorea/hemiballism. Isolated putamen and combined putamen-caudate nucleus involvements were most common on neuroimaging studies with discrepancies between CT and MRI findings in about one-sixth of patients. Unilateral arm-leg combination was the most frequent with bilateral chorea in 9.7% of patients. Chorea and imaging anomalies did not appear concomitantly in one-tenth of patients. Successful treatment rates of chorea with glucose-control-only and additional anti-chorea medications were 25.7% and 76.2%, respectively, with an overall recurrence rate being 18.2%. The most commonly used anti-chorea drug was haloperidol. To date, four out of six pathological studies revealed evidence of hemorrhage as a probable pathogenesis.