Objective: To report a rare case of bilateral asterixis occurring one year after the onset of hemichorea-hemiballism in a patient with severe bilateral internal carotid artery stenosis, and to explore the potential hemodynamic mechanisms underlying this phenomenon.

Background: Bilateral asterixis is rarely caused by cerebrovascular disease.While hemichorea-hemiballism has been associated with cerebrovascular events, the equential development of bilateral asterixis following hemichorea-hemiballism has not been previously reported.

Method: We reported a case of an 83-year-old male patient with a history of multipile cerebrovascular events and severe bilateral internal carotid artery stenosis. Clinical data were collected retrospectively, including neuroimaging studies, laboratory reusults, and treatment responses.

Results: An 83-year-old man developed a left frontal lobe infarction due to left internal carotid artery (ICA) occlusion in X-17 and was started on aspirin. He subsequently developed persistent atrial fibrillation, leading to a switch from aspirin to apixaban. In March 2011, he developed a left thalamic infarction, and by May, he developed hemichorea-hemiballism in his right upper and lower limbs. The hemichorea-hemiballism improved with symptomatic treatment, but in December in X, he suddenly developed asterixis in both upper limbs. Laboratory data including liver and renal function tests, electrolytes and ammonia levels were unremarkable. No acute infarction was noted on MRI. Carotid ultrasonography revearled occlusion of the left ICA and 80% stenosis of the right ICA. Cerebral blood flow single-photon emission computed tomography demonstrated significant hypoperfusion in the bilateral cerebral hemispheres and basal ganglia, with more pronounced reduction in the left hemisphere compared to the right. The asterixis improved by fluid replacement.

Conclusion: The rapid improvement of asterixis improved with fluid replacement suggests a hemodynamic mechanism potentially involving of the cortico-subcortical pathways involving the basal ganglia, motor thalamus, and cerebellum occurred due to severe stenosis of both internal carotid arteries. Furthermore, we hypothesize that changes in the localization of the ischemic areas within the circuit led to variations in the expression of involuntary movements.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-bilateral-asterixis-following-hemichorea-hemiballism-due-to-bilateral-internal-carotid-artery-stenosis/