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[Case report: hemiballism due to a putaminal cavernous hemangioma]
No to Shinkei = Brain and Nerve
|November 1, 1989
Summary
A rare case of reversible hemiballism in a woman was linked to a putaminal cavernous hemangioma. Hemiballism symptoms fluctuated with minor hemorrhages and absorption, suggesting a unique pathophysiology.
Area of Science:
- Neurology
- Neuroimaging
- Pathology
Background:
- Hemiballism is a rare hyperkinetic movement disorder.
- Putaminal lesions can cause hemiballism, but reversible cases are exceptionally rare.
Observation:
- A 51-year-old woman presented with left-sided hemiballism and weakness.
- Cranial CT revealed a high-density, enhancing lesion in the right putamen.
- MRI showed an isodense lesion on T1 and a ring-like low-signal area on T2, suggestive of cavernous hemangioma.
Findings:
- CT-guided stereotaxic biopsy revealed gliosis and calcification, not cavernoma.
- A small hemorrhage occurred post-biopsy, temporarily ceasing hemiballism.
- Hemiballism recurred as the hemorrhage resolved, indicating a fluctuating neurological state.
Implications:
- The on-off hemiballism suggests a pathophysiology involving fluctuating putaminal lesion activity and its effect on basal ganglia pathways.
- This case highlights the complex relationship between cavernous hemangiomas, hemorrhage, and movement disorders.
- Understanding this mechanism may inform future management strategies for similar rare neurological presentations.