Pure Hemi-Chorea Resulting from an Acute Phase of Contralateral Thalamic Lacunar Infarction: A Case Report

Abstract

Background: Thalamic lesions give rise to a variety of clinical syndromes such as pure sensory stroke, ataxic hemiparesis, and rarely involuntary movements including chorea. Generally and classically, lacunar infarction in the subthalamic nucleus has been regarded as the lesion mainly responsible for hemi-chorea and hemi-ballismus, on the basis of previous anatomical studies. Case Presentation: This report describes the case of an 81-year-old man who developed sudden-onset pure hemi-chorea in the right limbs resulting from an acute phase of left thalamic lacunar infarction detected on a diffusion-weighted image (DWI) in an MRI study. The patient had no other neurological symptoms such as ataxic hemiparesis and sensory disturbance. A single-photon emission computed tomography (SPECT) study using the ^99mTc-ECD Patlak plot method demonstrated significant perfusional asymmetry between the right and left thalami (p = 0.0035), consistent with the left thalamic lesion on DWI. Conclusion: It is speculated that this perfusional asymmetry, in particular the hypoperfusion in the left thalamus, detected by SPECT might play the most important role in the contralateral pure hemi-chorea as a rare neurological manifestation in this case.

Antibiotic Treatment Attenuates Behavioral and Neurochemical Changes Induced by Exposure of Rats to Group A Streptococcal Antigen

“…Of the immunological and neurochemical measures that were taken in the present study, IgG deposits in the thalamus are the only one which parallels the pattern of behavioral deficits in the food manipulation task (i.e., no IgG deposits – no motor deficit). In humans, damage to the thalamus caused by stroke can lead to choreic movements [56] , [57] and thalamic structural and functional alterations are correlated with motor symptoms in disorders such as SC, TS, Huntington’s disease, Parkinson’s disease and schizophrenia [58] – [63] . In animals, different manipulations that disrupt thalamic functioning lead to motor alterations such as reduced grip strength, involuntary clasping movement and impairments in limb coordination and balance [64] , [65] .…”

Movement Disorders Following Cerebrovascular Lesion in the Basal Ganglia Circuit

“…Very few cases of chorea or ballism associated with isolated thalamic infarction have been reported. One study demonstrated that hypoperfusion of the STN and globus pallidus using a (99m) Tc-ethyl cysteinate dimer-single photon emission computed tomography associated with the development of chorea after stroke [ 26 ].…”

Uncus Herniation Presenting as Immediate Onset Postoperative Hemichorea

“…1 Thalamic and subthalamic lesions are commonly known to cause hemichorea. 2,3 In this interesting case report, we describe a patient with hydrocephalus due to aqueductal stenosis which caused hemichorea in the immediate postoperative period due to subthalamic infarct. The infarct was due to posterior cerebral artery (PCA) involvement as a result of uncus herniation.…”