Painful tonic spasms caused by putaminal infarction.

Area of Science:

• Neurology
• Neuroscience
• Vascular Neurology

Background:

• Lacunar infarcts in the basal ganglia are associated with movement disorders like chorea and dystonia.
• Putaminal lacunar infarcts are less common but can present with unique neurological symptoms.

Observation:

• A patient presented with paroxysmal, painful, flexor contractures of the limbs, termed "painful tonic spasms."
• These spasms were contralateral to a putaminal lacunar infarction.
• The spasms were not epileptic seizures and responded to carbamazepine treatment.

Findings:

• The putaminal lacunar infarction was likely caused by lupus anticoagulant and systemic lupus erythematosus.
• This case expands the spectrum of movement disorders associated with basal ganglia lacunar infarcts.
• Carbamazepine demonstrated efficacy in managing these specific painful tonic spasms.

Implications:

• Highlights the diverse clinical presentations of basal ganglia lacunar infarcts.
• Suggests a potential etiological link between autoimmune conditions (lupus) and specific infarct-related movement disorders.
• Provides evidence for carbamazepine as a treatment option for infarct-induced painful tonic spasms.