Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity

Abstract

Background and purpose: Post-stroke movement disorders (PMDs) following ischemic lesions of the basal ganglia (BG) are a known entity, but data regarding their incidence are lacking. Ischemic strokes secondary to proximal middle cerebral artery (MCA) occlusion treated with thrombectomy represent a model of selective damage to the BG. The aim of this study was to assess the prevalence and features of movement disorders after selective BG ischemia in patients with successfully reperfused acute ischemic stroke (AIS).

Methods: We enrolled 64 consecutive subjects with AIS due to proximal MCA occlusion treated with thrombectomy. Patients were clinically evaluated by a movement disorders specialist for PMDs onset at baseline, and after 6 and 12 months.

Results: None of the patients showed an identifiable movement disorder in the subacute phase of the stroke. At 6 and 12 months, respectively, 7/25 (28%) and 7/13 (53.8%) evaluated patients developed PMDs. The clinical spectrum of PMDs encompassed parkinsonism, dystonia and chorea, either isolated or combined. In most patients, symptoms were contralateral to the lesion, although a subset of patients presented with bilateral involvement and prominent axial signs.

Conclusion: Post-stroke movement disorders are not uncommon in long-term follow-up of successfully reperfused AIS. Follow-up conducted by a multidisciplinary team is strongly advisable in patients with selective lesions of the BG after AIS, even if asymptomatic at discharge.

Keywords: acute ischemic stroke; basal ganglia; mechanical thrombectomy; post‐stroke movement disorders.

FIGURE 1

Flowchart of the study. AIS, acute ischemic stroke; BG, basal ganglia; FU, follow‐up; LVO, large vessel occlusion; MT, mechanical thrombectomy; MCA, middle cerebral artery; mTICI, modified treatment in cerebral ischemia score; MRI, magnetic resonance imaging.

FIGURE 2

Prevalence and clinical subtype of post‐stroke movement disorders (PMDs) 6 months (a) and 12 months (b) after the acute event. D, dystonia; D+C, combined dystonia‐chorea; PMD−, patients who did not develop PMD during the follow‐up; PMD+, patients who developed a PMD throughout the follow‐up; P, parkinsonism; P+D, combined parkinsonism‐dystonia.

FIGURE 3

Selective ischemic lesion of the basal ganglia occurring after an acute proximal occlusion of the middle cerebral artery in a patient successfully treated with mechanical thrombectomy from our cohort. Panels a and b: T2‐weighted sequences coronal sections at the level of the basal ganglia. Panels c and d panels: diffusion‐weighted sequences axial sections at the level of the basal ganglia.