Objective

To describe clinical features, diagnostic challenges, and therapeutic response of diabetic striatopathy in Latin American patients, an underrepresented population in current literature, and to highlight the importance of early recognition and interdisciplinary collaboration in improving diagnosis and management.

Methods

Case series of two Latin American women with poorly controlled type 2 diabetes mellitus who developed hyperkinetic movement disorders. Clinical presentation, neuroimaging findings, diagnostic approach, and clinical outcomes following metabolic and symptomatic treatment were analyzed.

Results

One patient presented with acute-onset chorea accompanied by pain and hypoesthesia, with striatal hyperdensity on computed tomography and T1 hyperintensity on magnetic resonance imaging, achieving complete symptom resolution within 48 hours after intensive insulin therapy. The second patient developed progressive choreiform movements, initially misdiagnosed as epilepsy, without response to antiepileptic drugs. Neuroimaging confirmed diabetic striatopathy; insulin therapy produced partial improvement, and adjunctive haloperidol reduced movement severity, with residual symptoms at discharge. Both cases demonstrated characteristic imaging findings despite distinct clinical phenotypes.

Conclusions

Diabetic striatopathy shows heterogeneous clinical presentations and may mimic other neurological disorders, leading to diagnostic delays. Early recognition and prompt glycemic control are essential, although treatment response varies and may require individualized management strategies.

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