Movement disorders of probable infectious origin

Abstract

Background:Movement disorders (MDs) associated with infections remains an important debilitating disorder in the Asian countries.Objectives:The objective of the following study is to report the clinical and imaging profile of a large cohort of patients with MDs probably associated with infection.Materials and Methods:This was a chart review of 35 patients (F:M-15:20) presenting with MD in the Neurology services of National Institute of Mental Health and Neurosciences, India. The demographic profile, type of infection, time from infection to MD, phenomenology of MD and magnetic resonance imaging (MRI) findings were reviewed.Results:The mean age at presentation was 22.6 ± 13.3 years, (5-60), age of onset of MD was 15.7 ± 15 years, and duration of symptoms was 6.9 ± 8.1 years (42 days to 32 years). The mean latency of onset of MD after the infection was 5.9 ± 4.2 weeks. The phenomenology of MD were: (1) Pure dystonia-28.6%, (2) dystonia with choreoathetosis-22.9%, (3) Parkinsonism-14.6%, (4) pure tremor, hemiballismus, myoclonus and chorea-2.9% each, and (5) mixed MD-22.9%. Most often the MD was generalized (60%), followed by right upper limb (31.4%) and left upper limb (8.6%). A viral encephalitic type of neuroinfection was the most common infection (85.7%), which was associated with MD. Abnormalities of brain MRI, seen in 79.2%, included signal changes in (1) thalamus-52.0%, (2) putamen and subcortical white matter-16% each, (3) pons-12%, (4) striatopallidum, striatum and grey matter-8% each, and (5) caudate, cerebellum, lentiform nucleus, midbrain and subthalamic nucleus-4.0% each.Conclusions:MDs associated with infection were the most often post-encephalitic. Dystonia was the most common MD, and thalamus was the most common anatomical site involved.

Hemichorea‐Hemiballism: An Uncommon Presentation of Central Nervous System Tuberculosis

“…Indeed, hemiballismus, chorea, tremor, dystonia, athetosis, myoclonic jerks, and ataxia have all been associated with CNS‐Tb with a prevalence range of 18% to 36.4%, depending on the presence of tuberculomas 4,5 . Treatment for tuberculomas is the same that is established for meningeal tuberculosis with a combination of isoniazid, rifampin, ethambutol, and pyrazinamide daily for 2 months, then isoniazid and rifampin for 7 to 10 months with an excellent clinical outcome in the cases reported previously 4–8 . Given the relative recent reemergence of Tb as a critical health problem, being the first infectious cause of death in the world, 9 and the increased of CNS‐Tb, specifically in HIV‐infected patients, 10 our case emphasizes the need for early recognition and prompt treatment.…”

Clinical spectrum and management of dystonia in patients with Japanese encephalitis: A systematic review

“…Movement disorders (MD) can be primary, which is a presentation of an underlying neurodegenerative disorder, or secondary that arises from other disease states or brain injury (Jhunjhunwala et al., 2014). Infections, cerebrovascular disease, space‐occupying lesions, and trauma have been described as various etiological factors causing secondary MDs (SMDs) (Mehanna & Jankovic, 2013).…”

Secondary Movement Disorder in a Case of Diphtheric Encephalitis: Clinical and Neuroimaging Features of a Rare Association

“…Infections account for up to a fifth of SMDs, with the most-common subtype being pure dystonia or dystonia combined with other disorders 3. A wide variety of underlying bacterial and viral pathogens have been reported 3.…”

“…Infections account for up to a fifth of SMDs, with the most-common subtype being pure dystonia or dystonia combined with other disorders 3. A wide variety of underlying bacterial and viral pathogens have been reported 3. These usually occur in the pediatric age group and manifest within 1 month of a febrile illness, although the latency period can vary widely 3.…”

“…A wide variety of underlying bacterial and viral pathogens have been reported 3. These usually occur in the pediatric age group and manifest within 1 month of a febrile illness, although the latency period can vary widely 3. Neuroimaging commonly demonstrates involvement of the basal ganglia and thalamus, with variable involvement of the midbrain, cortex, and white matter 4…”