Objective: Case study

Background: Complex hyperkinetic movement disorders are a rare complication of stroke, frequently involving posterolateral contralateral thalamic lesions. One of the proposed mechanisms for these presentations is proprioceptive impairment, hence not involving deregulation of the basal ganglia-thalamocortical circuits.

Method: The case will be presented with video.

Results: We present a case of a patient with dystonic posturing and athetoid movements with onset two years after right fronto-parieto-temporal stroke. The movements were first noticed two months before consultation, and had worsened since. The patient recognized the arm as its own and could control it. However, when he was not paying attention it would drift to an abnormal position. He denied the arm ever trying to perform any task by its own or interfere with the contralateral arm. On the neurological examination, he had previously known left agraphesthesia and astereognosia, mild left paresis, left hypoalgesia, proprioceptive impairment and mild ataxia of the left arm. He also had de novo dystonic posturing of the left arm and hand, slow writhing movements of the left hand and fingers and slow convoluted movements of the left arm. These movements were arrhythmic and intermittent. Wider movements would occur when distracted, with the member drifting up and backwards. Brain MRI showed no thalamic lesion. Based on the phenomenology a diagnosis of pseudochoreoathetosis was proposed.

Conclusion: Choreoathethosis is characterized by slow and irregular writhing movements, most often associated with dystonia, commonly affecting the whole limb that are not jerky or abrupt in nature. Pseudochoreathetosis is indistinguishable from true choreoathetosis but occurs with proprioception impairment, caused by a lesion anywhere along the proprioceptive pathways, including the striatum. It is most often associated with thalamic lesion and, in case series of stroke patients, postero-lateral thalamic lesion seemed to be always involved. It normally presents subacutely, within days to weeks from the acute event, although it can occur up to four years after.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dystonic-posturing-with-athetoid-movements-in-stroke-without-thalamic-lesion/