Acute hand dystonia and action myoclonus unveiling diabetic striatopathy: The critical role of hyperglycemia.

Abstract

Background: Diabetic striatopathy is a rare complication of diabetes mellitus characterised by movement disorders secondary to hyperglycemia. While most commonly associated with chorea and ballism, it may also present with other hyperkinetic manifestations, including, albeit rarely, isolated dystonia and myoclonus. We report a case of a patient with poorly controlled diabetes mellitus who developed acute hand dystonia and action myoclonus, highlighting the broader spectrum of hyperglycemia-induced movement disorders.

Case report: A 64-year-old male with poorly controlled type 2 diabetes mellitus presented with acute dystonic posturing of the right hand and action myoclonus of the right forearm. On admission, his blood glucose was 648 mg/dL, with a glycated hemoglobin of 13.5%. Neurological examination revealed these motor abnormalities, while brain magnetic resonance imaging showed global cortical atrophy without acute lesions. Following the initiation of insulin therapy, abnormal movement disorders resolved within 6 h as blood glucose levels decreased to 253 mg/dL.

Discussion: This case highlights the importance of prompt recognition and treatment of hyperglycemia in patients with new-onset movement disorders. Diabetic striatopathy should be considered in the differential diagnosis, even in the absence of chorea or ballism, as glycemic control can lead to rapid symptom resolution. Although isolated dystonia and myoclonus in diabetic striatopathy are rare, their occurrence broadens the spectrum of hyperglycemia-induced movement disorders. Early diagnosis and management of hyperglycemia are essential for optimising patient outcomes. Further research is needed to characterise the spectrum and underlying mechanisms of diabetic striatopathy fully.