Journal of Neurology

, Volume 260, Issue 12, pp 2986–2992 | Cite as

Cortical hemichorea–hemiballism

  • Kyoung Jin Hwang
  • Il Ki Hong
  • Tae-Beom AhnEmail author
  • Sang Hun Yi
  • Dokyung Lee
  • Deog Yoon Kim
Original Communication


Hemichorea–hemiballism (HCHB) was infrequently related to cortical lesions such as tumor or infarction. Although functional derangement of the basal ganglia (BG) or the thalamus (Th) was suggested, pathomechanism of HCHB secondary to cortical lesions remains uncertain. We recruited the patients with HCHB secondary to cerebrovascular diseases, excluding other causes such as hyperglycemia. All the patients were studied with brain magnetic resonance imaging/angiography (MRI/MRA) and single-photon emission computed tomography (SPECT). Those with only cortical abnormalities in neuroimaging studies were sorted out as the cases of cortical HCHB. Statistical parametric mapping (SPM) analysis of SPECT was performed to investigate the pathomechanism of cortical HCHB. Ten patients (three males and seven females) were included in our study. Six patients had acute BG lesions with SPECT abnormalities, and one had old BG lesions with abnormal SPECT. Three patients were classified as cortical HCHB with lesions only in the frontal and parietal cortices in MRI and SPECT. SPM analysis revealed additional hypoperfusion in frontal areas, leaving BG and Th free of any perfusion abnormalities. Although cortical HCHB was strictly defined by MRI and SPECT, cortical HCHB was not uncommon (30 %). Further analysis showed intertwined networks among the frontal and parietal lobes for cortical HCHB. Cortical dysfunction is important in the pathogenesis of cortical HCHB even without significant involvement of BG and Th.


Hemichorea Hemiballism Single-photon emission computed tomography (SPECT) Statistical parametric mapping (SPM) 


Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 Her abnormal movements are jerky, of large amplitude and flinging movement, compatible with hemiballism. Her hemiballism suddenly started. She turns over at the request of us (at 27 s). Initial violent hemiballism subsides (at 45 s) and intermittent ballistic movements follow (MPG 10724 kb)


  1. 1.
    Martin JP (1957) Hemichorea (hemiballismus) without lesions in the corpus Luysii. Brain 80(1):1–10CrossRefPubMedGoogle Scholar
  2. 2.
    Gilon D, Constantini S, Reches A (1990) Hemiballism as a presentation of a meningioma. Eur Neurol 30(5):277–278CrossRefPubMedGoogle Scholar
  3. 3.
    Mizushima N, Park-Matsumoto YC, Amakawa T, Hayashi H (1997) A case of hemichorea−hemiballism associated with parietal lobe infarction. Eur Neurol 37(1):65–66CrossRefPubMedGoogle Scholar
  4. 4.
    Lee MS, Lyoo CH, Lee HJ, Kim YD (2000) Hemichoreoathetosis following posterior parietal watershed infarction: was striatal hypoperfusion really to blame? Mov Disord 15(1):178–179CrossRefPubMedGoogle Scholar
  5. 5.
    Lyoo CH, Oh SH, Joo JY, Chung TS, Lee MS (2000) Hemidystonia and hemichoreoathetosis as an initial manifestation of moyamoya disease. Arch Neurol 57(10):1510–1512CrossRefPubMedGoogle Scholar
  6. 6.
    Al-Yacoub M, Friedman JH, Fernandez HH (2004) Hemiballismus from a parietal stroke in a Parkinson patient. Mov Disord 19(8):986–988CrossRefPubMedGoogle Scholar
  7. 7.
    Chung SJ, Im JH, Lee MC, Kim JS (2004) Hemichorea after stroke: clinical-radiological correlation. J Neurol 251(6):725–729CrossRefPubMedGoogle Scholar
  8. 8.
    Srivastava T, Singh S, Goyal V, Shukla G, Behari M (2006) Hemichorea−hemiballism associated with frontoparietal bleed. J Neurol 253(5):653–654CrossRefPubMedGoogle Scholar
  9. 9.
    Vidakovic A, Dragasevic N, Kostic VS (1994) Hemiballism: report of 25 cases. J Neurol Neurosurg Psychiatry 57(8):945–949CrossRefPubMedGoogle Scholar
  10. 10.
    Ghika-Schmid F, Ghika J, Regli F, Bogousslavsky J (1997) Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci 146(2):109–116CrossRefPubMedGoogle Scholar
  11. 11.
    Postuma RB, Lang AE (2003) Hemiballism: revisiting a classic disorder. Lancet Neurol 2(11):661–668CrossRefPubMedGoogle Scholar
  12. 12.
    Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J Roentgenol 149(2):351–356CrossRefGoogle Scholar
  13. 13.
    Friston KJ, Holmes AP, Worsley KJ, Frith CD, Heather JD, Frackowiak RSJ (1995) Statistical parametric maps in functional images: a general linear approach. Hum Brain Mapp 2:180–210Google Scholar
  14. 14.
    Friston KJ, Ashburner J, Poline J, Frith CD, Heather JD, Frackowiak RSJ (1995) Spatial realignment and normalization of images. Hum Brain Mapp 2:165–189CrossRefGoogle Scholar
  15. 15.
    Talairach J, Tournoux P (1988) Co-planar stereotactic atlas of the human brain. Thieme, StuttgartGoogle Scholar
  16. 16.
    Dewey RB, Jankovic J (1989) Hemiballism–hemichorea. Clinical and pharmacologic findings in 21 patients. Arch Neurol 46(8):862–867CrossRefPubMedGoogle Scholar
  17. 17.
    Ristic A, Marinkovic J, Dragasevic N, Stanisavljevic D, Kostic V (2002) Long-term prognosis of vascular hemiballismus. Stroke 33(8):2109–2111CrossRefPubMedGoogle Scholar
  18. 18.
    Rossetti AO, Ghika JA, Vingerhoets F, Novy J, Bogousslavsky J (2003) Neurogenic pain and abnormal movements contralateral to an anterior parietal artery stroke. Arch Neurol 60(7):1004–1006CrossRefPubMedGoogle Scholar
  19. 19.
    Filimon F (2010) Human cortical control of hand movements: parietofrontal networks for reaching, grasping, and pointing. Neuroscientist 16(4):388–407CrossRefPubMedGoogle Scholar
  20. 20.
    Bar-Gad I, Morris G, Bergman H (2003) Information processing, dimensionality reduction and reinforcement learning in the basal ganglia. Prog Neurobiol 71(6):439–473CrossRefPubMedGoogle Scholar
  21. 21.
    Kim JS, Lee KS, Lee KH, Kim YI, Kim BS, Chung YA, Chung SK (2002) Evidence of thalamic disinhibition in patients with hemichorea: semiquantitative analysis using SPECT. J Neurol Neurosurg Psychiatry 72(3):329–333CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kyoung Jin Hwang
    • 1
  • Il Ki Hong
    • 2
  • Tae-Beom Ahn
    • 1
    Email author
  • Sang Hun Yi
    • 1
  • Dokyung Lee
    • 1
  • Deog Yoon Kim
    • 2
  1. 1.Department of Neurology, School of MedicineKyung Hee UniversitySeoulRepublic of Korea
  2. 2.Department of Nuclear Medicine, School of MedicineKyung Hee UniversitySeoulRepublic of Korea

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