Background:
A 60-year-old man with a history of HIV, cocaine use, and diabetes was brought to the ED after he was found down at home. On neurologic examination, he was somnolent and confused but had no additional deficits. He was admitted to the intensive care unit with a diagnosis of diabetic ketoacidosis. Computed tomography of the head showed hyperdense right caudate and lentiform nuclei without surrounding edema or mass effect. Magnetic resonance imaging of the head demonstrated a corresponding hyperintensity in the same region. A diagnosis of diabetic striatopathy (DS) was made. In contrast to intracranial hemorrhage, imaging in patients with DS demonstrates the absence of perilesional edema with sparing of the thalamus and white matter. Although patients with DS typically present with unilateral chorea or ballismus, hyperkinetic movements may be absent, as in this case. After correction of DKA, his encephalopathy resolved and he was discharged home
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