Diabetes is one of the most prevalent chronic diseases worldwide, affecting approximately 11% of the adult population globally. The most common neurologic complication is diabetic neuropathy. Diabetic striatopathy refers to a rare clinical-radiological syndrome caused by chorea-ballismus and increased striatal signal in the image, either tomography or magnetic resonance imaging of the skull. Although there are no epidemiological studies, a prevalence of less than 1/100,000 inhabitants is estimated. Being a rare complication of diabetes, a high index of suspicion and promptly correcting metabolic dysregulation are important to prevent long-term complications. It has classically been documented in elderly women of Asian descent, with type 2 diabetes and a non-ketotic hyperosmolar hyperglycemic state. But in recent years, it has been reported in a wide variety of diabetic patients. It is characterized by being reversible, with specific treatment of hyperglycemia. The pathophysiological mechanism underlying diabetic striatopathy remains incompletely understood. More recent reports have expanded the clinical spectrum of the non-ketotic hyperglycemic state, describing neurological manifestations with movement disorders and characteristic MRI findings beyond chorea. Some patients require the use of other drugs for symptomatic treatment while euglycemia is achieved. Cases of persistence of movements and atrophy of the caudate have been reported when an adequate and timely diagnosis and treatment are not performed. Recurrence reaches 4 to 20%, so it is important to establish a close follow-up of these patients. In this presentation, we will review the main clinical and radiological features of diabetic striatopathy, together with its proposed pathophysiological mechanisms and current management strategies.  

Lucía Castro is a neurologist and assistant professor in the department of neurology at Hospital de clínicas, Montevideo, Uruguay. I completed my neurology training in 2024 and earned a master's degree in neuroimmunology in 2026. I currently work at Hospital de clínicas and in private practice.