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[Symptomatic chronic hemichorea of a vascular lesion in the contralateral putamen]
L Redondo1, J Chacón, J Valencia
1Servicio de Neurologia, Hospital Universitario Virgen Macarena, Sevilla.
Insights
This study details a rare case of chronic chorea linked to a unilateral ischemic putamen lesion. The findings suggest potential alterations in basal ganglia circuits may cause chorea instead of dystonia.
Area of Science:
- Neurology
- Neuroscience
- Vascular Neurology
Background:
- Basal ganglia lesions, particularly in the putamen, are typically associated with dystonia and Parkinsonism.
- Chorea is more commonly linked to lesions in the caudate nucleus.
Observation:
- A patient presented with chronic multifocal choreiform dyskinesia.
- This dyskinesia showed a clear anatomical and temporal link to a contralateral putamen lesion of ischemic origin.
Findings:
- The case highlights the rare occurrence of chorea associated with a unilateral ischemic putamen lesion.
- The exact pathogenic mechanisms remain unclear, prompting further investigation.
Implications:
- This case suggests that putamen lesions might, in some instances, selectively disrupt basal ganglia circuits, leading to chronic chorea rather than dystonia.
- Further research is needed to elucidate the neurobiological pathways underlying this phenomenon.
Abstract:
We present a case of chronic multifocal choreform dyskinesia with evident anatomical and temporal relationship with a contralateral putamen lesion of ischaemic origin after embolism originating in a partially thrombosed intracavernous caratid aneurysm. Isolated putamen lesions are associated with abnormal dystonic type involuntary movements, bilateral to Parkinsonisms, sometimes associating both these types of movements, and lesions involving the cauda giving rise to choreic movements. Given the rarity in the literature of this entity, chorea associated with unilateral ischaemic putamen lesion, and the absence of pathogenic mechanisms which might satisfactorily explain it, we propose a series of possibilities which could underlie this type of chorea. If putamen macroscopic lesions are really more associated with dystonic manifestations, it is possible that, in some cases they might selectively alter base ganglia circuits and bring on chronic choreas rather than dystonia.