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[Chorea due to chronic subdural hematoma].
Tomotaka Shiraishi1, Renpei Sengoku1, Shigehiko Takanashi2
1Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology.
Rinsho Shinkeigaku = Clinical Neurology
|June 5, 2018
Summary
Chronic subdural hematoma (CSDH) can cause chorea, a movement disorder. Surgical evacuation of the CSDH led to complete resolution of chorea in this patient, highlighting a potential treatment.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Movement disorders like chorea can have diverse etiologies.
- Chronic subdural hematoma (CSDH) is typically associated with neurological deficits, but chorea is an unusual presentation.
Observation:
- An 86-year-old woman presented with progressive chorea affecting the face and extremities.
- Cranial CT identified a left parietal chronic subdural hematoma (CSDH).
- Amantadine withdrawal did not resolve the chorea.
Findings:
- Surgical evacuation of the CSDH resulted in complete resolution of chorea within one week.
- This case, along with prior reports of unilateral CSDH causing hemichorea, suggests a link between CSDH and chorea.
- The underlying pathophysiology may involve pre-existing neuronal network dysfunction in the basal ganglia-cerebral cortex.
Implications:
- CSDH should be considered in the differential diagnosis of new-onset chorea, particularly in elderly patients.
- Further investigation including neuroimaging, family history, and medication review is crucial for identifying precipitating factors.
- This case underscores the importance of addressing structural brain lesions in managing movement disorders.
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