Hemichorea-Hemiballism in a Patient with Temporal-Parietal Lobe Infarction Appearing After Reperfusion by Recombinant Tissue Plasminogen Activator.
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SUBMITTER: Murakami T
PROVIDER: S-EPMC6353402 | biostudies-literature | 2015 Dec
REPOSITORIES: biostudies-literature
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Hemichorea-Hemiballism in a Patient with Temporal-Parietal Lobe Infarction Appearing After Reperfusion by Recombinant Tissue Plasminogen Activator.
Murakami Takenobu T Wada Tomohiro T Sasaki Itaru I Yoshida Kenji K Segawa Mari M Kadowaki Suguru S Yoshihara Akioh A Kobayashi Shunsuke S Hoshi Akihiko A Sugiura Yoshihiro Y Ugawa Yoshikazu Y
Movement disorders clinical practice 20150720 4
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Project description:ObjectiveHyperglycemia may cause acute central nervous system dysfunction manifesting as agonizing involuntary movements due to insult to the basal ganglia. We report a case of hemichorea-hemiballism (HCHB) in a patient with diabetes.MethodClinical assessment of the patient was performed, along with laboratory tests and brain imaging.ResultsThe patient was a 50-year-old man with newly detected diabetes with persistent involuntary movement of the right upper and lower limbs for few weeks. The involuntary movement was nonrhythmic, nonpatterned, purposeless, and often jerky with variable amplitude and frequency, sometimes wild and flailing in the form of hemichorea with a ballistic component (HCHB). He had a history of poor compliance to prescribed oral antidiabetic drugs. At presentation, although he was hemodynamically stable, random capillary blood glucose level was 18 mmol/L and glycated hemoglobin A1 level was 15.1% (141.5 mmol/mol). Clinical examination did not reveal any focal deficit or positive Babinski sign. There was a hyperintensity in the left basal ganglia region in T1-weighted magnetic resonance imaging (MRI) of the brain, which was iso-to-hyperintense in T2-weighted image and fluid-attenuated inversion recovery sequence. There was no restriction of diffusion on the diffusion-weighted image or blooming on gradient echo sequences, indicating absence of infarction or hemorrhage. Control of hyperglycemia resulted in disappearance of the involuntary movement within 1 month.ConclusionWhile there are many differential diagnoses for HCHB, the clinical scenario suggests hyperglycemia as the underlying cause in this patient. This case reiterates that multiple central nervous system manifestations may be attributable to diabetes.
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Project description:Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion.We describe a rare case of postoperative ipsilateral hemiballism in a patient who underwent pituitary adenoma resection and experienced a right internal cerebral artery territory infarct. We review the literature on hemichorea hemiballismus (HCHB) and explore various mechanisms for its occurrence.Only three cases of ipsilateral hemiballism have been described, and the exact pathophysiology remains unknown. A dominant left hemisphere with corpus callosal connections to the right basal ganglia is the most probable explanation for this unusual event.
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