Objective: This case illustrates acute hemichorea as a rare manifestation of right temporo-parietal infaction.

Background: Acquired chorea can result from structural, metabolic, infectious pharmacological, or autoimmune etiologies. While chorea is a rare presentation of cerebrovascular disease, it is classically associated with basal ganglia or thalamic lesions. The pathophysiology underlying stroke-related chorea, particularly resulting from isolated cortical lesions, remains poorly understood.

Method: 77 year-old male patient presented with a 2-day history of sudden-onset, involuntary movements in his left arm and leg. He reported no familial history of chorea, offending medications, or other aggravating factors. Neurological examination revealed left-sided hemichorea without hemiparesis or hemispatial neglect. A brain CT ruled out acute cerebral hemorrhage. Diffusion-weighted MRI demonstrated acute ischemic infarctions in right temporal and parietal lobe.

Results: He was treated with dual antiplatelet therapy (aspirin and clopidogrel) for infarction, alongside clonazepam and risperidone for hyperkinetic symptom control. On hospital day 2, chorea was alleviated and the ambulation seemed quite well. Brain MRI and angiography were undergone and showed no further deterioration of acute stroke lesion. The patient discharged on hospital day 6.

Conclusion: While further evaluations are necessary to exclude genetic or metabolic etiologies, clinicians should consider acute cortical ischemic stroke in differential diagnosis of sudden-onset chorea, even in the absence of basal ganglia involvement.

References: Movement disorders in cerebrovascular disease. Mehanna R, et al. Lancet Neurol. 2013. PMID: 23602779 Review.
Hemiballism: revisiting a classic disorder. Postuma RB, Lang AE. Lancet Neurol. 2003 Nov;2(11):661-8. doi: 10.1016/s1474-4422(03)00554-4.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-hemichorea-as-a-rare-presentation-of-right-temporoparietal-infarction-a-case-report/