Cortical hemichorea–hemiballism

Hemichorea–hemiballism (HCHB) was infrequently related to cortical lesions such as tumor or infarction. Although functional derangement of the basal ganglia (BG) or the thalamus (Th) was suggested, pathomechanism of HCHB secondary to cortical lesions remains uncertain. We recruited the patients with...

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Bibliographic Details
Published in:Journal of neurology 2013-12, Vol.260 (12), p.2986-2992
Main Authors: Hwang, Kyoung Jin, Hong, Il Ki, Ahn, Tae-Beom, Yi, Sang Hun, Lee, Dokyung, Kim, Deog Yoon
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Angiography
Cerebral Cortex - pathology
Cerebrovascular Disorders - complications
Chorea - etiology
Chorea - pathology
Dyskinesias - etiology
Dyskinesias - pathology
Female
Humans
Image Processing, Computer-Assisted
Magnetic resonance imaging
Male
Medical imaging
Medicine
Medicine & Public Health
Neuroimaging
Neurology
Neuroradiology
Neurosciences
Original Communication
Pathogenesis
Retrospective Studies
Tomography
Tomography, Emission-Computed, Single-Photon
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Summary:Hemichorea–hemiballism (HCHB) was infrequently related to cortical lesions such as tumor or infarction. Although functional derangement of the basal ganglia (BG) or the thalamus (Th) was suggested, pathomechanism of HCHB secondary to cortical lesions remains uncertain. We recruited the patients with HCHB secondary to cerebrovascular diseases, excluding other causes such as hyperglycemia. All the patients were studied with brain magnetic resonance imaging/angiography (MRI/MRA) and single-photon emission computed tomography (SPECT). Those with only cortical abnormalities in neuroimaging studies were sorted out as the cases of cortical HCHB. Statistical parametric mapping (SPM) analysis of SPECT was performed to investigate the pathomechanism of cortical HCHB. Ten patients (three males and seven females) were included in our study. Six patients had acute BG lesions with SPECT abnormalities, and one had old BG lesions with abnormal SPECT. Three patients were classified as cortical HCHB with lesions only in the frontal and parietal cortices in MRI and SPECT. SPM analysis revealed additional hypoperfusion in frontal areas, leaving BG and Th free of any perfusion abnormalities. Although cortical HCHB was strictly defined by MRI and SPECT, cortical HCHB was not uncommon (30 %). Further analysis showed intertwined networks among the frontal and parietal lobes for cortical HCHB. Cortical dysfunction is important in the pathogenesis of cortical HCHB even without significant involvement of BG and Th.
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-013-7096-7