Clinical features of hemichoreahemiballism: A stroke-related movement disorder

Abstract

We examined pathogenesis and clinical features of three hemichorea-hemiballism (HCHB) cases. We studied their age, magnetic resonance imaging results, vascular risk factors, management, and outcomes. One man and two women (aged 74-86 years) demonstrated acute onset of HCHB, lasting for at least several months. Patients had one or more vascular risk factors, including hypertension and diabetes. All patients presented subacute or old infarction in the basal ganglia with contralateral symptoms. We administered clonazepam (0.5-1 mg/day), haloperidol (0.375-0.75 mg/day), or both as necessary and observed symptom-control. Vascular lesions in the basal ganglia were a contributing factor. Symptoms were controlled using pharmacotherapy with gamma-aminobutyric acid-agonist (clonazepam) or anti-dopaminergic (haloperidol) medication.

Keywords: Hemichorea-hemiballism; Strokerelated movement disorders; basal ganglia.

Figure 1.

Magnetic resonance image findings for the three hemichorea-hemiballism cases. In case 1, brain magnetic resonance image (MRI) shows the old cerebral infarct in the right globus pallidus present for the past four years (A: T2 weighted MRI image (T2WI)at the onset, B: T2WI at the four years before the onset). In case 2, MRI shows the subacute cerebral infarcts in the right globus pallidus (C; Diffusion weighted image(DWI), D; T2WI, and E; Fluid attenuated inversion recovery(FLAIR)). In case 3, MRI shows periventricular hyperdensity (PVH), old infarcts in right globus pallidus and putamen (F; FLAIR, G; T2WI, and H; T2WI).

Figure 2.

Clinical courses of the three hemichorea-hemiballism (HCHB) cases (A; case 1, B; case 2, C; case 3) X means the year when HCHB occurred.