Diabetic Striatopathy Following Radiological Improvement: An Autopsy-confirmed Case Report and Literature Review

Abstract

Diabetic striatopathy (DS) is a rare neurological complication in poorly controlled diabetes mellitus. The pathogenesis of DS is thought to involve microvascular injury; however, autopsy-based histological documentation remains scarce. We report an autopsy-confirmed case of DS complicated by right cerebellar hemorrhagic infarction, in which hemichorea developed despite radiological improvement. A histological examination showed neuronal loss, reactive astrocytosis, calcification, and organizing hemorrhage with fibroblast proliferation in the basal ganglia within 82 days after the initial imaging. These findings highlight the paradox between radiological normalization and irreversible pathological injury, supporting DS as a spectrum that extends from functional disturbance to structural damage.