Objective: to investigate the clinical features and the occurrence in the long-term follow-up of PMDs in patients with BG lesions due to deep ICH.

Background: Post-stroke movement disorders (PMDs) are a known complication of cerebrovascular lesions involving the basal ganglia (BG)^1,2. Their prevalence among stroke survivors ranges between 1-4%³, but could be underestimated due to studies heterogeneity and ambiguity in the definition of PMDs themselves^4,5. Deep intracerebral hemorrhage (ICH) commonly affects the BG while sparing the lobar cortices⁶, making them a representative model for BG network disruption with preserved cortical functioning. However, the epidemiology of PMDs in the long-term follow-up among BG hemorrhage survivors remains unclear.

Method: Patients admitted to our stroke unit for deep ICH between 2020-2023 were retrospectively identified. Subjects were contacted by phone and invited to our clinic for a neurological follow-up to evaluate the possible onset of PMDs. The neurological assessment included motor, cognitive and functional scales. Diagnosis of post-stroke parkinsonism was confirmed only in presence of a combination of significant (UPDRS III score >2 in at least one items) bradykinesia and tremor/rigidity⁵. Patients with confounding spasticity/hemiparesis were considered as PMDs non-developers.

Results: Twenty patients were evaluated, while the remaining subjects were lost to follow-up (consent refusal/severe disability/death; Figure 1). Clinical features of our study population are summarized in Table 1.

Among those evaluated, 7/20 (35%) patients had developed a PMD. None of them presented with confounding spasticity, previous dopamine-receptor blockers intake, or family history of movement disorders. Four subjects exhibited parkinsonism, two dystonia, and one combined parkinsonian and dystonic features. Symptoms distribution was lateralized, with greater burden in the body side opposite to the lesion. Dystonic symptoms were mild and restricted to the hand opposite to the ICH. In one subject the abnormal hand posture was associated to intermittent, distal, involuntary jerky movements.

Conclusion: PMDs are not uncommon after selective hemorrhagic infarction of the BG. Clinicians should be aware of the clinical relevance of PMDs in deep ICH survivors. PMDs development should be routinary assessed in the follow-up of selective cerebrovascular BG injuries to maximize diagnosis and treatment.

Figure 1: Flowchart of the study

Table 1: Characteristics of the study population

References: 1. Berlot, R., Pavlović, A. & Kojović, M. Secondary parkinsonism associated with focal brain lesions. Front Neurol 15, (2024).
2. Ghika-Schmid, F., Ghika, J., Regli, F. & Bogousslavsky, J. Hyperkinetic movement disorders during and after acute stroke: The Lausanne Stroke Registry. J Neurol Sci 146, (1997).
3. Suri, R. et al. Post-stroke Movement Disorders: The Clinical, Neuroanatomic, and Demographic Portrait of 284 Published Cases. Journal of Stroke and Cerebrovascular Diseases 27, (2018).
4. Pandey, S. et al. Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders. (2022) doi:10.1002/mds.29218.
5. Rigon, L. et al. Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity. Eur J Neurol (2024) doi:10.1111/ENE.16219.
6. Puy, L. et al. Intracerebral haemorrhage. Nature Reviews Disease Primers 2023 9:1 9, 1–18 (2023).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/post-stroke-movement-disorders-following-infarction-of-the-basal-ganglia-a-pilot-study/