A Case of Complete Resolution of Hemiballismus After Carotid Endarterectomy

Abstract

Background: Hemiballismus is a rare presentation of symptomatic carotid stenosis that is underreported in the neurosurgical literature. It is characterized by severe large-amplitude movements that are classically caused by lesions of the subthalamic nucleus. Given the arterial border zone position of the subthalamic nucleus between the anterior and posterior circulation, hemodynamically compromising carotid stenosis can lead to hypoperfusion in this location.

Case description: We describe the case of a patient who presented with acute-onset hemiballismus that had complete resolution of symptoms after carotid endarterectomy.

Conclusions: We suggest that neurovascular imaging should be part of the initial workup of this condition and that prompt diagnosis and treatment of carotid artery stenosis in patients who present with new-onset hemiballismus are essential for reducing risk of imminent stroke.

Keywords: Carotid stenosis; Endarterectomy; Hemiballismus; Limb shaking; Transient ischemic attack.