title: Diabetic striatal disease: clinical presentation, neuroimaging, and pathology.
abstract: BACKGROUND
  Unilateral movement disorders and contralateral neuroimaging abnormalities of the striatum have been sporadically reported as a rare syndrome associated with diabetes mellitus. Despite characteristic imaging findings and clinical manifestations, the mechanism underlying this syndrome is still unclear.
  
  
  METHODS
  Six patients with this syndrome were studied clinically and subjected to MRI neuroimaging; one underwent biopsy of the striatum, and another underwent additional MR spectroscopy at 3.0T and FDG-PET.
  
  
  RESULTS
  Neuroimaging findings were characterized by a T1-hyperintense unilateral lesion restricted to the striatum, contralateral to the symptomatic limbs. The biopsied striatum contained patchy necrotic tissue, severe thickening of all layers of arterioles, and marked narrowing of vessel lumens. Hyaline degeneration of the arteriolar walls, extravasation of erythrocytes, and prominent capillary proliferation were also notable, together with lymphocytic infiltration and macrophage invasion. In one patient, PET examination revealed decreased accumulation of FDG in the lesion. The MR spectrum for the diseased striatum revealed a decrease in the NAA/Cr ratio (1.35), normal Cho/Cr ratio (1.22), and a peak for myoinositol, while the spectrum on the contralateral site revealed a decrease in the NAA/Cr ratio (1.48), increase in Cho/Cr (1.32), but no peak for myoinositol.
  
  
  CONCLUSIONS
  The constellation of signs and symptoms and neuroimaging characteristics in previous reports and the six additional cases described here with neuropathological data and findings of MR spectroscopy appears unique enough to be termed "diabetic striatopathy." This syndrome appears in poorly controlled diabetics due to obliterative vasculopathy with prominent vascular proliferation, vulnerability to which is restricted to the striatum.
authors: Department of Neurology, Southern Tohoku Research Institute for Neuroscience, Koriyama. ayoshinori10@hotmail.com
authors: Yoshinori
authors: Y
authors: Abe
authors: Teiji
authors: T
authors: Yamamoto
authors: Tomoko
authors: T
authors: Soeda
authors: Tomohiro
authors: T
authors: Kumagai
authors: Yoshihiro
authors: Y
authors: Tanno
authors: Jin
authors: J
authors: Kubo
authors: Tetsuya
authors: T
authors: Ishihara
authors: Soichi
authors: S
authors: Katayama
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D002819:Chorea / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D003401:Creatine / Q000378:metabolism; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013577:Syndrome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline