Objective: We present a case of acute hemichorea secondary to cortical infarction in the MCA territory.

Background: Acute abnormal movements secondary to stroke occur in 1-4% of these. The most common is hemichorea-hemiballismus. The lesion is usually located in the contralateral basal ganglia and rarely in the cortex.

Method: An independent 50-year-old man with a history of ulcerative colitis consulted the emergency services for clumsiness in the left limbs on awakening. At evaluation, he presented dysarthria, dysmetria, hemihypoesthesia, and left sensory and visual extinction. The NIHSS was 6. In addition, he presented involuntary choreic movements of the left side of the face and upper limb, which were filmed with his consent.

Results: An urgent neuroimaging study was performed using CT, which demonstrated hypodensity in the right insula-M2-M3-M6 territories and a subocclusive dissection of both internal carotids (ICAs). The perfusion showed an increase in Tmax in the areas described, with a favorable core. Revascularization treatment was not performed due to the unknown onset and the absence of occlusion. A month later, a cranial MRI showed a right insular and parietotemporal lesion respecting the basal ganglia, and an occlusion of the right ICA. The patient maintained left sensory hypoesthesia and extinction but the abnormal movements ceased.

Conclusion: Although the most typical location and cause of an ischemic lesion that causes hemicorporal movements is located contralateral to the basal ganglia and is usually caused by a lacunar/hemorrhagic stroke, it must be taken into account that a small percentage is produced by cortical lesions that may be caused by a major vessel occlusion, being a candidate for a mechanical thrombectomy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-movement-disorder-with-atypical-topography-acute-hemichorea-secondary-to-cortical-stroke/