Diabetic striatopathy presenting as stroke-mimicking hemiparesis without involuntary movements: A case report

Diabetic striatopathy is a rare complication of uncontrolled diabetes, typically presenting with involuntary movements, striatal hyperdensity on computed tomography, and T1-weighted hyperintensity on magnetic resonance imaging. We describe a 52-year-old woman with hyperosmolar hyperglycemic state (glucose 34.0 mmol/L; osmolality 323 mOsm/kg) who developed left-sided weakness without chorea or ballism. Brain computed tomography showed subtle hypodensity of the right caudate nucleus and putamen, closely mimicking acute ischemic stroke; densitometry demonstrated a consistent side-to-side difference (5.89 Hounsfield units, P < .001). T1-weighted imaging showed concordant hyperintensity in the same region (mean per-pair signal-intensity ratio 1.117, P < .001). The weakness resolved within 1 week of glycemic optimization. Follow-up imaging at 12 months showed normalization of the signal abnormality (mean per-pair signal-intensity ratio 0.979, near unity). To our knowledge, the combination of movement-free, stroke-mimicking presentation with nonhemorrhagic striatal hypodensity showing no evidence of acute infarction has not been previously reported. Whether this reflects the timing of imaging relative to metabolic correction rather than a distinct radiologic entity remains to be established.