Hemibalismo: relato de oito casos

Abstract

granuloma fúngico (criptococo) subtalâmico associado a SIDA. Entre os pacientes com diabetes mellitus, três apresentavam hiperglicemia não cetótica, dois dos quais com hemorragias nos gânglios da base, e três acidente vascular encefálico isquêmico. Em 75% dos casos ocorria também hemicoréia, com acometimento predominante do dimídio direito. Do total de pacientes seis apresentaram boa resposta clínica ao tratamento farmacológico com neurolépticos. Dois pacientes foram submetidos a talamotomia estereotáxica, um dos quais apresentou remissão completa do hemibalismo. Em nossa série de oito pacientes com hemibalismo houve predominância da associação com diabetes mellitus e acidente vascular encefálico, e boa evolução clínica.PALAVRAS-CHAVE: hemibalismo, diabetes mellitus, acidente vascular encefálico. Hemiballism: report of eight casesABSTRACT -We report eight cases of hemiballism. Six patients had diabetes mellitus, one patient presented with porencephaly after cranial trauma and one patient had a HIV-associated fungic granuloma (cryptococcus). In the diabetic group three patients had non-ketotic hyperglycemia; two of them with striatal hemorrhage, and the remaining three presented with an ischemic stroke. Hemichorea occurred in 75% of our patients, predominantly in the right side of the body. Six patients had good improvement with treatment with haloperidol and two patients had to undergo a thalamotomy, one of them with good results. In our series of eight patients with hemiballismus we observed an association with diabetes mellitus and stroke, and good clinical improvement.

Distúrbio de movimento por conta de estado hiperosmolar não cetótico em idosa: relato de caso

“…1 Geralmente, eles resultam de lesões estruturais no núcleo subtalâmico e estriado contralateral e possuem várias etiologias, especialmente os eventos vasculares. 2 Na ausência de lesão vascular focal, devem ser consideradas, principalmente, as alterações metabólicas, a neoplasia cerebral e as infecções do sistema nervoso central (SNC). 3 Os exames de imagem em hemicoreia-hemibalismo causados por hiperglicemia não cetótica descrevem, frequentemente, hiperdensidade (tomografia) ou hiperintensidade (RM em T1) no estriado.…”

Subthalamic Nucleus: Neuroanatomical Review

“…26 Experimental motivation studies have established that STN lesions do not increase hunger, but rather stimulate food motivation, explaining the mechanisms of clinical reports of hyperphagia induced by lesions in the STN. [27][28][29][30][31]…”

Movement disorders emergencies: a review

“…The term derives from the Greek word ballismos, which means "jumping about or dancing. " This MD most often involves one side of the body, but, occasionally, bilateral movements occur, a condition then defined as biballism [46][47][48] . The most consistent neuropathological finding in hemiballism is a lesion of the contralateral subthalamic nucleus (STN), usually of vascular origin 49 .…”

“…However, lesions in different locations are not uncommon, including the ipsilateral STN, caudate nucleus, putamen, thalamus, substantia nigra, and the premotor and motor cortex 50 . Also, other causes have been described, as metabolic disorders (nonketotic hyperglycemia, hypoglycemia, hyperthyroidism), Sydenham's chorea (chorea insatiens), systemic lupus erythematosus/antiphospholipid syndrome, post-operative period of cardiac surgery with extracorporeal circulation (post-pump chorea), infectious diseases of the central nervous system (e.g., human immunodeficiency virus infection, toxoplasmosis, syphilis, abscess), tumors and multiple sclerosis [47][48][49] . Frequently, hemiballism is associated to hemichorea and, then, the term hemiballism-hemichorea (HBC) is used to describe this clinical spectrum 48,49 .…”

“…Mild chorea often does not require treatment; however, when the hyperkinetic movements are of sufficient severity to cause functional disability and exhaustion, several different approaches have been advocated 47,[50][51][52][53][54] . A combination of a benzodiazepine with either haloperidol, olanzapine or tetrabenazine, titrated over days to maintain a balance between control of the movement disorder and side effects, such as sedation, can be effective 47,50,51 . Other options include gabapentin, valproic acid 55 , and, as a last resort, stereotactic surgery 51 .…”