Hemiballism with leg predominance caused by contralateral subthalamic haemorrhage

Abstract

Hemiballism is a rare movement disorder characterised by high-amplitude movements of the limbs on one side of the body. Stroke of the contralateral basal ganglia, especially the subthalamic nucleus (STN) is the most common aetiology of acute development of hemiballism. Recently, the pathophysiology of hemiballism has been associated with abnormal firing patterns in the globus pallidus interna, with intermittent firing bursts followed by pauses, during which movements occur. An 87-year-old woman presented with a 5-day history of hemiballism predominantly in her leg. On the basis of her brain MRI findings, she was diagnosed as having vascular hemiballism caused by haemorrhage in the contralateral STN. Treatment with risperidone led to the clinical resolution of her condition. We discuss the distribution of the patient's ballistic movements on the basis of the somatotopic organisation of the STN.

Brachiocephalic artery aneurysm plaque rupture, stroke & repair

“…Within this, hemiballismus-hemichorea is the most common cause [1] . The most frequent neuroanatomical localisation of this is to the contralateral basal ganglia, and in particular the subthalamic nucleus [2] . An important differential to consider is a limb shaking transient ischemic attack, which is a rare hypoperfusion syndrome secondary to high grade contralateral internal carotid artery stenosis [3] .…”