Yusof, Nurul Nadiah and Abd Rahman, Mohd Aizuddin and Che Yusof, Mohd Daud and Ibrahim, Shahirah (2026) When stroke is not stroke : diabetic striatopathy presenting as hemichorea in primary care. In: 28th Family Medicine Scientific Conference 2026, 4-7 September 2026, Pahang, Malaysia.
|
PDF
- Published Version
Download (389kB) | Preview |
Abstract
Introduction: Diabetic striatopathy is a rare but reversible neurological manifestation of poorly controlled diabetes mellitus characterized by hemichorea and basal ganglia abnormalities on neuroimaging. Due to its stroke-like presentation, delayed recognition may result in diagnostic uncertainty and prolonged morbidity. Case Presentation: We report a 61-year-old Malay woman with longstanding uncontrolled Type 2 Diabetes Mellitus, hypertension, hypertensive cardiomyopathy, and hyperlipidaemia who had defaulted follow-up for two years. She presented with progressively worsening involuntary dance-like movements involving the left upper and lower limbs associated with facial twitching for two weeks. The abnormal movements were non-suppressible, improved during sleep, and significantly impaired daily functioning. Initial neurological assessment raised suspicion of acute stroke; however, computed tomography of the brain was unremarkable. Laboratory investigations revealed severe hyperglycaemia with HbA1c of 17.4%, random blood glucose of 13.1 mmol/L, and negative ketonuria. Discussion: She was diagnosed with left hemichorea secondary to metabolic causes and initially treated with clonazepam with no response despite improving glycaemic control. In view of persistent symptoms, early magnetic resonance imaging was arranged, demonstrating T1-weighted hyperintensity in the right basal ganglia, consistent with non-ketotic hyperglycemic hemichorea syndrome, also known as diabetic striatopathy. Risperidone was initiated, followed by adjunctive topiramate in collaboration with the neuromedical team, resulting in marked clinical improvement within one month alongside intensive diabetic optimisation. Conclusion: This case highlights the importance of recognising diabetic striatopathy as a reversible stroke mimic in primary care. Early recognition, timely neuroimaging, multidisciplinary management, and aggressive glycaemic optimisation are essential to prevent prolonged disability and achieve favourable functional recovery.
| Item Type: | Proceeding Paper (Poster) |
|---|---|
| Uncontrolled Keywords: | Hemichorea, Hyperglycemia, Diabetes Mellitus Type II |
| Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology R Medicine > RC Internal medicine > RC66 Clinical cases |
| Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): | Kulliyyah of Medicine > Department of Family Medicine (Effective: 1st January 2011) Kulliyyah of Medicine |
| Depositing User: | DR MOHD AIZUDDIN ABD RAHMAN |
| Date Deposited: | 22 Oct 2026 12:37 |
| Last Update: | 22 Oct 2026 12:37 |
| Queue Number: | 2026-10-Q5777 |
| URI: | http://irep.iium.edu.my/id/eprint/132176 |
| Indexed In: | UNSPECIFIED |
Actions (login required)
 |
View Item |