A 50 year old male with history of type 2 diabetes mellitus (DM), baseline left-sided hemiparesis, presented with worsening left sided weakness in the setting of DKA. CT head revealed well delineated right basal ganglia hyperdensity, initially thought to be a hemorrhage. MRI brain revealed T1 hyperintensity in right basal ganglia, suspicious for DS. Patient presented as stroke mimic and no abnormal movements were reported.
A 78 year old female with history of type 2 DM presented after a fall. She had three weeks of abnormal movements in her right arm and right leg, causing multiple falls. Labs revealed HbA1c >18. Video EEG didn’t capture any abnormal right sided movements. CT head showed hyperintensity in the left basal ganglia. MRI brain showed increased T1 signal within the left basal ganglia consistent with DS. No further abnormal movements were reported after strict glycemic control.
A 73 year female with history of type 2 DM, presented with confusion and facial asymmetry. Lab revealed HbA1c of 16.1 and she was in DKA. CT head showed hyperintensity in the right basal ganglia. MRI brain showed increased T1 signal within the right basal ganglia consistent with DS. MRI also revealed multiple embolic strokes. Although this patient had radiographic findings consistent with DS, there were no abnormal movements reported.