Hemichorea Associated with Ipsilateral Chronic Subdural Hematoma —Case Report—

Yoshikawa, Mineka; Yamamoto, Makoto; Shibata, Kenji; Ohta, Keiji; Kamite, Y; Takahashi, Masaru; Shimizu, Y; Ohba, Shinji; Kuwabara, Satoshi; Uozumi, Tohru

doi:10.2176/nmc.32.769

Cited by 15 publications

(8 citation statements)

References 15 publications

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“…5 Hemichorea is a relatively uncommon movement disorder that usually follows an ischemic or hemorrhagic lesion in the contralateral caudate nucleus or putamen, corona radiata. 2,4,5 Lesions outside these structures may also be associated with hemichorea. Among the reported cases of choreiform movements associated with chronic SDH there were three bilateral and five unilateral hematoma cases.…”

Section: Discussionmentioning

confidence: 99%

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Acute hemichorea associated with ipsilateral chronic subdural hematoma

et al. 2020

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Here we are describing left-sided hemichorea in a 71-year-old female which developed within 3 days without any history of weakness, unconsciousness, fever, headache, vomiting. She had a history of head trauma 5 year back. No abnormality was detected in routine blood investigations. Computed tomography revealed a left chronic subdural hematoma. Neurosurgical intervention in form of left temporal “burr hole” drainage was performed and the patient’s involuntary movements improved in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

“…The etiology of chorea varies widely but chorea associated with chronic subdural hematoma (SDH) is rare and very few cases have been reported so far. [1][2][3][4] Here we are reporting a case with acute hemi choreiform movements associated with ipsilateral chronic SDH.…”

Section: Introductionmentioning

confidence: 96%

Acute hemichorea associated with ipsilateral chronic subdural hematoma

et al. 2020

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“…It is possible that the cause is the high-pressure load to the basal nuclei in a possible anomaly of neurotransmitters and possibly also because of transient ischemia that the high hematoma pressure may cause. 4,[6][7][8][9] In fact the high pressure may lead to a severe compression and distortion of the encephalon and subcortical structures, in particular, the caudate.…”

Section: Discussionmentioning

confidence: 99%

Choreic Syndrome Secondary to a Subdural Hematoma

Pistacchi¹,

Gioulis²,

Marsala³

2016

The Neurologist

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The Neurologist 2016;21:32-33)T he etiology of chorea is heterogeneous, 1 however, chorea associated with chronic subdural hematoma (SDH) is rare. [2][3][4][5] We report a patient with bilateral chorea associated with chronic SDH which was surgically treated. CASE REPORTA 76-year-old woman with previous history of seronegative rheumatoid arthritis treated with hydroxychloroquine was admitted later, with the onset about a month earlier of bilateral involuntary movements and mental confusion. Initially, the patient showed especially fidgeting and irritability that preceded the development of the movement disorders. With time, chorea highlights with hyperkinetic movements, such as myoclonic jerks and dystonia at the head, first left upper and lower limb and then in all extremities. Objective neurological examination performed at the admission in our department showed a good state of space-time orientation, good ability to perform calculations, and no praxis disorders. However, in about a month, we observed severe axial choreic involuntary movements, first left upper and lower limb and then in all 4 limbs. Brain computed tomography (CT) scan showed the presence of a layer of subdural chronic-type hematoma with contralateral shift of the midline of about 12 mm with slight herniation of the right cerebellar tonsil in the right frontotemporoparietal cortex (Fig. 1). One day later she underwent a small temporoparietal craniotomy, incision of the dura mater with blood leakage at high pressure. At the end of surgery, progressive reexpansion of the brain was rapidly highlighted. Within a few days, involuntary movements were completely regressed to achieve a complete normalization of the clinical neurological examination. Another brain CT scan performed 1 month later was normal (Fig. 2). DISCUSSIONThe presence of choreic syndrome secondary to an SDH is rare but not that uncommon. It is possible that the cause is the high-pressure load to the basal nuclei in a possible anomaly of neurotransmitters and possibly also because of transient ischemia that the high hematoma pressure may cause. 4,6-9 In fact the high pressure may lead to a severe compression and distortion of the encephalon and subcortical structures, in particular, the caudate.The mechanism responsible of parkinsonism in chronic SDH patients is not well understood. Various hypotheses may be argued including mechanical pressure on the basal ganglia, either directly from the overlying hematoma or indirectly by torsion or displacement of the brain structure 10 ; midbrain compression caused by the uncal herniation through the tentorial notch 11 ; decreased number of dopaminergic receptors in the striatum secondary to mechanical pressure 12 ; and finally, circulatory disorders within the basal ganglia as a consequence of displacement and compression of the anterior choroidal artery. 4 FIGURE 1. First brain computed tomography. FIGURE 2. Second brain computed tomography.From the

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“…Early studies correlated hemiballism with lesions in the subthalamic nucleus, however, in a review of 21 patients only 5 had an identifiable lesion in the subthalamic nucleus [29]. Hemiballism has been reported in association with an ipsilateral chronic subdural hematoma [140], and in four patients as a manifestation of subcortical white matter ischemia [40]. Hemiballism may be the first sign of non-ketotic hyperglycemia [77,99].…”

Section: Hemiballism-hemichoreamentioning

confidence: 99%

Movement disorder emergencies

Poston

Frucht

2008

J Neurol

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Movement disorder emergencies include any movement disorder which evolves over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. It is crucial that doctors recognize these emergencies with accuracy and speed by obtaining the proper history and by being familiar with the phenomenology of frequently encountered movements. These disorders will be discussed based on the most common associated involuntary movement, either parkinsonism, dystonia, chorea, tics or myoclonus, and, when available, review the workup and treatment options based on the current literature.

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Hemichorea Associated with Ipsilateral Chronic Subdural Hematoma —Case Report—

Cited by 15 publications

References 15 publications

Acute hemichorea associated with ipsilateral chronic subdural hematoma

Acute hemichorea associated with ipsilateral chronic subdural hematoma

Choreic Syndrome Secondary to a Subdural Hematoma

Movement disorder emergencies

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