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Hemiballism-Hemichorea

  • Ronald B. Postuma
  • Anthony E. Lang
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Patient 1: A 69-year-old man was followed at the Toronto Western Hospital with a 7-year history of Parkinson’s disease (PD). Other past medical history included diabetes, coronary artery disease, and a previous stroke involving the right frontal lobe. Two weeks before presentation, he noticed the acute onset of involuntary movements of the left side, predominantly affecting the arm but also involving the leg and face. They tended to worsen soon after taking his levodopa. Clinical examination showed choreic movements of the left arm. Interestingly, the bradykinesia and rigidity were significantly ameliorated on the left side. Magnetic resonance imaging (MRI) examination demonstrated an infarction of the posterior putamen and globus pallidus, extending upwards into the periventricular white matter (seeFig. 1). Dopaminergic medications were decreased, resulting in improvement of his symptoms. During his admission, he began to have spontaneous improvement in symptoms, and did not require therapy.

Keywords

Deep Brain Stimulation Subthalamic Nucleus Typical Neuroleptic Toronto Western Hospital Basal Ganglion Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Dewey RB, Jankovic J. Hemiballism-hemichorea. Clinical and pharmacologic findings in 21 patients. Arch Neurol 1989;46:862–867.PubMedGoogle Scholar
  2. 2.
    Ghika-Schmid F, Ghika J, Regli F, Bogousslavsky J. Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci 1997;146:109–116.PubMedCrossRefGoogle Scholar
  3. 3.
    Ristic A, Marinkovic J, Dragasevic N, Stanisavljevic D, Kostic V. Long-term prognosis of vascular hemiballismus. Stroke 2002;33:2109–2111.PubMedCrossRefGoogle Scholar
  4. 4.
    Oh SH, Lee KY, Im JH, Lee MS. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. J Neurol Sci 2002;200:57–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Chu K, Kang DW, Kim DE, Park SH, Roh JK. Diffusion-weighted and gradient echo magnetic resonance findings of hemichorea-hemiballismus associated with diabetic hyperglycemia: a hyperviscosity syndrome? Arch Neurol 2002;59:448–452.PubMedCrossRefGoogle Scholar
  6. 6.
    Shan DE, Ho DM, Chang C, Pan HC, Teng MM. Hemichorea-hemiballism: an explanation for MR signal changes. AJNR 1998;19:863–870.PubMedGoogle Scholar
  7. 7.
    Ohara S, Nakagawa S, Tabata K, Hashimoto T. Hemiballism with hyperglycemia and striatal T1-MRI hyperintensity: an autopsy report. Mov Disord 2001;16:521–525.PubMedCrossRefGoogle Scholar
  8. 8.
    Shefner J. Ballism. In: Joseph A, Young R, eds. Movement Disorders in Neurology and Neuropsychiatry. Blackwell Science, Malden, Mass: 1999;475–480.Google Scholar
  9. 9.
    Crossman AR, Sambrook MA, Jackson A. Experimental hemichorea/hemiballismus in the monkey. Studies on the intracerebral site of action in a drug-induced dyskinesia. Brain 1984;107(Pt 2):579–596.Google Scholar
  10. 10.
    DeLong MR. Primate models of movement disorders of basal ganglia origin. Trends Neurosci 1990;13:281–285.PubMedCrossRefGoogle Scholar
  11. 11.
    Guridi J, Obeso JA. The subthalamic nucleus, hemiballismus and Parkinson’s disease: reappraisal of a neurosurgical dogma. Brain 2001;124:5–19.PubMedCrossRefGoogle Scholar
  12. 12.
    Lenz FA, Suarez JI, Metman LV, et al. Pallidal activity during dystonia: somatosensory reorganisation and changes with severity. J Neurol Neurosurg Psychiatry 1998;65:767–770.PubMedCrossRefGoogle Scholar
  13. 13.
    Suarez JI, Metman LV, Reich SG, Dougherty PM, Hallett M, Lenz FA. Pallidotomy for hemiballismus: efficacy and characteristics of neuronal activity. Ann Neurol 1997;42:807–811.PubMedCrossRefGoogle Scholar
  14. 14.
    Vitek JL, Chockkan V, Zhang JY, et al. Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 1999;46:22–35.PubMedCrossRefGoogle Scholar
  15. 15.
    Riley D, Lang AE. Hemiballism in multiple sclerosis. Mov Disord 1988;3:88–94.PubMedCrossRefGoogle Scholar
  16. 16.
    Hyland H, Foreman D. Prognosis in hemiballismus. Neurology 1957;7:381–391.PubMedGoogle Scholar
  17. 17.
    Johnson WG, Fahn S. Treatment of vascular hemiballism and hemichorea. Neurology 1977;27:634–636.PubMedGoogle Scholar
  18. 18.
    Klawans HL, Moses H, III, Nausieda PA, Bergen D, Weiner WJ. Treatment and prognosis of hemiballismus. N Engl J Med 1976;295:1348–1350.PubMedCrossRefGoogle Scholar
  19. 19.
    Shannon K. Ballism. In: Jankovic J, Tolosa E, eds. Parkinson’s Disease and Movement Disorders. Williams and Wilkins, Baltimore: 1998;:365–375.Google Scholar
  20. 20.
    Grandas F. Ballism. In: Jankovic J, Tolosa E, eds. Parkinson’s Disease and other Movement Disorders. Lippincott Williams and Wilkins, Philadelphia: 2002; 234–239.Google Scholar
  21. 21.
    Ranawaya R, Lang AE. Neurological Emergencies in Movement Disorders. In: Weiner W, ed. Emergent and Urgent Neurology. J.B. Lippincott, Philadelphia: 1992; 277–319.Google Scholar
  22. 22.
    Krauss JK, Mundinger F. Functional stereotactic surgery for hemiballism. J Neurosurg 1996;85:278–286.PubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2005

Authors and Affiliations

  • Ronald B. Postuma
    • 1
  • Anthony E. Lang
    • 1
  1. 1.Morton and Gloria Shulman Movement Disorder CenterToronto Western HospitalTorontoCanada

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