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[Abnormal movements of vascular origin]
Insights
Vascular-related chorea and dystonia present differently after stroke. Chorea symptoms resolve quickly, while dyskinesia types don't pinpoint lesion location or type.
Area of Science:
- Neurology
- Neuroscience
- Vascular Neurology
Context:
- Dyskinesias, including hemichorea and dystonia, can arise from cerebrovascular events.
- Understanding the relationship between lesion type, location, and dyskinesia presentation is crucial for diagnosis and management.
Purpose:
- To report on patients with hemichorea and dystonia of vascular origin.
- To analyze the clinical presentation, lesion characteristics, and outcomes in these patients.
Summary:
- This study details three cases of hemichorea and ten of dystonia linked to vascular brain lesions (ischemic infarcts, lacunar infarcts, intraparenchymal hematoma).
- Chorea patients experienced abrupt onset post-stroke with regressive evolution and good treatment response, unlike dystonia patients.
- Dyskinesia type was not indicative of lesion localization or nature. Multiple lesions, archaic reflexes, and cortical atrophy were observed in some patients, highlighting the role of overall impairment.
- Sensory deficits were present in seven patients. Computed tomography (CT) limitations in detecting focal lesions were noted in two cases with prior hemiparesis.
Impact:
- The findings emphasize that while dyskinesias indicate neurological dysfunction, their specific type may not precisely localize the vascular lesion.
- The study underscores the limitations of CT in identifying all focal cerebral lesions causing movement disorders.
- Recognizing these patterns aids in understanding the pathophysiology of vascular-induced movement disorders and informs diagnostic approaches.
Abstract:
Three patients with hemichorea and ten with dystonia of vascular origin are reported. Five were secondary to ischemic infarcts, two to lacunar infarcts, three to intraparenchymal hematoma, and in the remaining three the type of lesion could not be determined. The patients with chorea, as opposed to those with dystonia, presented abruptly immediately after the stroke, and had a regressive evolution and good therapeutic response. The type of dyskinesia was not useful to identify the precise localization of the lesion or to determine its nature. In addition, in 5 patients multiple lesions were found and 5 had release of archaic reflexes or cortical atrophy in CT; this shows the importance of the overall functional impairment and focal lesions in the genesis of dyskinesia. There were sensory deficits in 7 patients. In 2 patients lesions were not found in the CT in spite of the presence of previous hemiparesis; this suggests that this technique has limitations to discover focal cerebral lesions in patients with focal or hemicorporal dyskinesia.