Easily missed or misinterpreted: diabetic striatopathy in the course of ketotic hyperglycaemia

A 61-year-old man suffering from diabetes mellitus type 2 (DM2) for 10 years and a 67-year-old woman with no medical history developed subacutely unilateral involuntary movements. Laboratory tests revealed hyperglycaemia (random blood glucose levels: 470 mg/dL and 560 mg/dL, respectively) and elevated glycosylated haemoglobin A1c levels (15.4% and 13.1%, respectively) with positive urine ketones and normal blood gas analysis. HC-HB is a syndrome mostly associated with a non-ketotic hyperglycaemia, often described in elderly Asian women with poorly controlled DM2.1 2 Imaging usually shows unilateral potentially reversible hyperdensity on CT and T1-hyperintensity on MRI within the striatum, which are due to metabolic insult.1–4 We present two rare cases of Caucasians with HC-HB and a ketotic hyperglycaemic in the course of long-lasting as well as new-onset DM2.3 4 We demonstrate characteristic neuroimaging findings, which can be discrete and thus easily missed or misinterpreted.