Hemiballism: Unusual clinical manifestation in three patients with frontoparietal infarct

• Published in: Clinical neurology and neurosurgery 2020-01, Vol.188, p.105612-105612, Article 105612
• Main Authors: Cotroneo, Masina, Ciacciarelli, Antonio, Cosenza, Domenico, Casella, Carmela, Dell’Aera, Cristina, Grillo, Francesco, Fazio, Maria Carolina, La Spina, Paolino, Musolino, Rosa Fortunata
• Format: Article
• Language: English
• Subjects: Acute stroke; Aged; Cardiac arrhythmia; Cardiovascular disease; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Cerebral Angiography; Cerebral cortex; Diffusion Magnetic Resonance Imaging; Dyskinesias - physiopathology; Family medical history; Female; Frontal Lobe - blood supply; Frontal Lobe - diagnostic imaging; Frontoparietal cortex; Hemiballism; Hemichorea; Humans; Hyperdirect way; Ischemia; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - drug therapy; Ischemic Stroke - physiopathology; Lesions; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Medical imaging; Middle Aged; Movement disorder; Muscles; Neurology; Parietal Lobe - blood supply; Parietal Lobe - diagnostic imaging; Patients; Stroke; Subthalamic Nucleus; Thrombolysis; Thrombolytic Therapy; Ultrasonic imaging
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2019.105612

•Hemiballism was considered a sign of a lesion in the subthalamic nucleus.•We described cases of hemiballism with no lesions of subthalamic nucleus.•The frontoparietal cortex may be involved in the genesis of hemiballism. The term hemiballism-hemichorea refers to a movement disorder characterized by involuntary movements, often violent, described as uncontrollable jerking, flinging, flailing or kicking, involving proximal muscles of a limb and it is often associated with lesions in the subthalamic nucleus. In this report, we described three cases of hemiballism-hemichorea as the first manifestation of acute ischemic stroke with lesion in the frontoparietal region on brain MRI and no involvement of the subthalamic nucleus. One patient was treated with thrombolysis and recovered within one hour. The other patients recovered within 48 h from symptoms onset. The impairment of the recently described "hyperdirect way", in which the cortical signal reach directly the subthalamic nucleus, may underlie the symptoms. We support, with a clinical point of view, the role of the frontoparietal region in the genesis of the hemiballism-hemichorea. An acute onset of this symptom should lead to think to an acute stroke.