Objective: To study the phenotypes of post stroke movement disorders (PSMDs) and examine their correlations with neuroimaging and electrophysiology.

Background: Different stroke locations lead to distinct movement disorders, while a single phenotype may arise from multiple stroke sites.[1] The mechanisms underlying these associations remain unclear.[2] This study aimed to delineate the clinical spectrum, timing and lesion-location variability of PSMDs. Despite the high stroke burden in Indian subcontinent, data on PSMD patterns remain limited.

Method: Patients with prior stroke presenting to the Department of Neurology during the one-year study period from February 2025 to January 2026, with new onset involuntary movements were evaluated, including those developing movement disorders during the acute or early post stroke period. All patients underwent clinical examination and video documentation, with phenomenology confirmed by a movement disorder specialist. Neuroimaging reviewed and electrophysiological studies (SEMG or EEG) were performed when indicated.

PSMDs were classified by onset as early (<7 days), subacute (7 days-6 months), late (>6 months) and by phenomenology (tremor, dystonia, hemichorea, hemiballismus, myoclonus, dyskinesia, stereotypy and parkinsonism). In cases with multiple phenotypes, classification was based on dominant disorder.

Results: A total of 43 patients with PSMDs were identified, with a mean (SD) age at onset was 64.49 (12.09) years; 31 were male and 12 were female. Most common dominant phenotype was vascular parkinsonism (37.2%), followed by dystonia (25.58%) and tremor (18.60%). Mixed movement disorders observed in 13 patients (30.23%). Chorea (66.66%) and stereotypy (60%) most often presented early (<7 days), whereas vascular parkinsonism (87.5%) and dystonia (45.45%) commonly had delayed onset (>6 months). Tremor most frequently had subacute onset (50%). Lesion locations were heterogenous. Clinical outcomes were worsening in 13.9%, resolution in 2.32% and stable symptoms in 83.72%.

Conclusion: PSMDs exhibit diverse phenotypes with vascular parkinsonism most frequent, followed by dystonia and tremor. Early presentations were more common with chorea and stereotypy, while vascular parkinsonism and dystonia typically occurred later. These findings highlight the heterogeneity of PSMDs and emphasize the importance of clinico-radiological correlation.

References: 1) Mehanna R, Jankovic J. Movement disorders in cerebrovascular disease. Lancet Neurol. 2013;12(6):597–608.
2) Pandey S, Joutsa J, Mehanna R, Shukla AW, Rodriguez-Porcel F, Espay AJ. Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders. Mov Disord. 2022;37(10):1996-2007.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/poststroke-movement-disorders-clinical-neuroimaging-and-electrophysiological-correlates/