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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

Abstract

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.

Keywords

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

Notes

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)

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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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