case_images: PMC10861287_01
case_images: Clinical course. Blood glucose levels, the amount of insulin administered, and the course of symptoms after admission are described. The number of days was counted from the date of first admission.
case_images: cureus-0016-00000052223-i01.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i01.jpg
case_images: FIG1
case_images: The patient's clinical course is shown in Figure 1.
case_images: CT images. CT showed hyperdensity in the bilateral putamen (arrow). On day 75, hyperdensity in the bilateral putamen was attenuated compared with that on days 1 and 2. The number of days was counted from the date of first admission.
case_images: cureus-0016-00000052223-i02.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i02.jpg
case_images: FIG2
case_images: CT showed hyperdensity in the bilateral putamen and no evidence of cerebral edema (Figure 2B). The CT showed hyperdensity in the bilateral putamen (Figure 2C), which was attenuated compared with that at the time of the first admission.
case_images: MRI images on the fourth day. A: T1-weighted; B: T2-weighted; C: FLAIR (striatum); D: DWI; E: T2*; F: magnetic resonance angiography; G: FLAIR (white matter). Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in the white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging
case_images: cureus-0016-00000052223-i03.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i03.jpg
case_images: FIG3
case_images: On the fourth day, MRI showed hyperintensity in the left putamen on T1-weighted images (Figure 3A).
case_images: MRI images on day 16. A: T1-weighted; B: T2-weighted; C: FLAIR (striatum); D: DWI; E: ADC; F: T2*; G: FLAIR (white matter). Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in the white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging; ADC - apparent diffusion coefficient
case_images: cureus-0016-00000052223-i04.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i04.jpg
case_images: FIG4
case_images: MRI on the 16th day showed bilateral putamen hyperintensity on T1-weighted images (Figure 4A). 
case_images: Magnetic resonance spectroscopy (MRS) images. a: N-acetylaspartate/creatine ratio (NAA/Cr ratio) evaluated using MRS; b: choline/creatine ratio (Cho/Cr ratio) evaluated using MRS. Arrows indicate the area where the signal changed in the putamen. The number of days was counted from the date of first admission.
case_images: cureus-0016-00000052223-i05.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i05.jpg
case_images: FIG5
case_images: MRI on the 25th day showed bilateral putamen hyperintensity on T1-weighted images more clearly than on the fourth day and the 16th day (Figure 7A), and MRS showed a decreased NAA/Cr ratio in the left putamen (Figure 5B) on the 25th day. MRS performed on the 89th day showed a decrease in the NAA/Cr ratio and increased the Cho/Cr ratio in the left putamen, suggesting neuronal damage and gliosis (Figures 5C-F).
case_images: SPECT images. SPECT showed hypoperfusion in the left putamen (arrow). The number of days was counted from the date of first admission.. SPECT - single-photon emission computed tomography
case_images: cureus-0016-00000052223-i06.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i06.jpg
case_images: FIG6
case_images: MRI images on day 25. A: T1-weighted; B: T2-weighted; C: FLAIR (striatum); D: DWI; E: ADC; F: FLAIR (white matter). Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in the white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging; ADC - apparent diffusion coefficient
case_images: cureus-0016-00000052223-i07.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i07.jpg
case_images: FIG7
case_images: MRI on the 25th day showed bilateral putamen hyperintensity on T1-weighted images more clearly than on the fourth day and the 16th day (Figure 7A), and MRS showed a decreased NAA/Cr ratio in the left putamen (Figure 5B) on the 25th day.
case_images: MRI images on day 37. A: T1-weighted; B; T2-weighted; C: FLAIR (striatum); D: DWI; E: ADC; F: T2*; G: FLAIR (white matter); H: SWI. Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in the white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging; ADC - apparent diffusion coefficient; SWI - susceptibility-weighted imaging
case_images: cureus-0016-00000052223-i08.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i08.jpg
case_images: FIG8
case_images: MRI images on day 87. A: T1-weighted; B: T2-weighted; C: FLAIR (striatum); D: DWI; E: ADC; F: T2*; G: SWI; H: FLAIR (white matter). Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging; ADC - apparent diffusion coefficient; SWI - susceptibility-weighted imaging
case_images: cureus-0016-00000052223-i09.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i09.jpg
case_images: FIG9
case_images: MRI showed hyperintensity in the left putamen on T1-weighted images (Figure 9A).
case_images: Course of blood glucose and HbA1c. Glycemic control was good after the second admission, and no recurrence of diabetic striatopathy was observed.. HbA1c - glycosylated hemoglobin
case_images: cureus-0016-00000052223-i10.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i10.jpg
case_images: FIG10
case_images: With continued frequent insulin injections, the patient maintained good glycemic control after discharge and showed no recurrence of diabetic striatopathy (Figure 10).
case_images: MRI images on day 125. A: T1-weighted; B: T2-weighted; C: FLAIR (striatum); D: DWI; E: ADC; F: T2*; G: SWI; H: FLAIR (white matter). Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging; ADC - apparent diffusion coefficient; SWI - susceptibility-weighted imaging
case_images: cureus-0016-00000052223-i11.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i11.jpg
case_images: FIG11
case_images: MRI images taken five years after the onset of diabetic striatopathy. A: T1-weighted; B; FLAIR (striatum); C: DWI; D: ADC; E: MRA; F: FLAIR (white matter). Arrows indicate the area in which the signal changed in the putamen. Arrowheads indicate the area in which the signal changed in white matter. The number of days was counted from the date of first admission. Table 1 summarizes these findings.. FLAIR - fluid-attenuated inversion recovery; DWI - diffusion-weighted imaging; ADC - apparent diffusion coefficient; MRA - magnetic resonance angiography
case_images: cureus-0016-00000052223-i12.jpg
case_images: PMC10861287_01_cureus-0016-00000052223-i12.jpg
case_images: FIG12