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Hemiballism-hemichorea induced by subcortical ischemia
T Fukui1, Y Hasegawa, S Seriyama
1Department of Neurology, Showa University School of Medicine, Tokyo, Japan.
Summary
White matter ischemia can cause hemiballism-hemichorea, a movement disorder. Involuntary movements resolved as limb weakness worsened, suggesting subcortical white matter damage as a cause.
Area of Science:
- Neurology
- Neuroscience
- Cerebrovascular Diseases
Background:
- Hemiballism-hemichorea is characterized by involuntary, violent, and rapid movements, often affecting one side of the body.
- Cerebral ischemia typically presents with negative motor phenomena like weakness or paralysis.
- The precise pathophysiology of hemiballism-hemichorea, particularly its association with white matter lesions, requires further elucidation.
Observation:
- Four patients presented with hemiballism-hemichorea as the primary clinical manifestation of white matter ischemia.
- These patients exhibited "positive" motor symptoms, contrasting with the more common limb weakness seen in cerebral ischemia.
- Involuntary movements ceased in all patients as paresis (weakness) progressed.
Findings:
- Subcortical white matter infarction was identified in three patients.
- Hemodynamic hypoperfusion in the cerebral hemisphere contralateral to the dyskinetic movements was a potential cause.
- Neuroradiological examinations revealed no pathological changes near the subthalamic nucleus in any patient.
Implications:
- Ischemia affecting the subcortical white matter, independent of the basal ganglia or subthalamic nucleus, can induce hemiballism-hemichorea.
- This finding expands the understanding of movement disorders resulting from ischemic stroke.
- Highlights the potential for white matter lesions to manifest as hyperkinetic movement disorders.