Objective: To assess phenomenology and clinical- radiological correlation of post thalamic stroke movement disorders (MDs)
Background: Post stroke movement disorders (PSMD) are rare and have varied presentations including dystonia, chorea, tremors and athetosis. Mechanisms proposed to explain the origin of PSMDs include changes in neuronal membrane excitability, loss of perilesional GABAergic inhibition, enhanced glutamatergic transmission, and synaptic plasticity. Ghika et al in 1994 coined ‘the jerky dystonic unsteady hand’ for a complex delayed hyperkinetic syndrome in patients with thalamic infarcts in the posterior choroidal arterial territory . Gupta et al in a systemic review noted the ventrolateral thalamic nucleus was most commonly involved with mixed MD manifestations . We report similar findings aiming to establish the phenomenology and radiological correlation of post thalamic stroke MDs.
Method: Observational study of patients presenting with movement disorders with a documented history of thalamic stroke at our centre. Patients with strokes in other regions or having other primary or secondary causes of MD were excluded.
Results: 11 patients were included and all had hyperkinetic MDs contralateral to the side of the stroke. Tremor was seen in all. Predominant tremor type: Action in 7/11 patients, Rest in 4/11. In 10/11 the upper extremity was involved except for 1 case with toe involvement. Dystonia was seen in 7/11 patients and choreiform – pseudoathetotic movement was seen in 6/11. 9 of the 11 patients had a mixed pattern of MDs similar to ‘the jerky dystonic unsteady hand’. All the patients had proprioceptive loss on the side involved. 2 patients had acute post stroke MDs while 9 had a delayed onset ranging from 2 weeks to 6 years after the initial vascular insult. Of the 5 patients with available imaging, stroke type was hemorrhagic in 2 and ischemic in 3. In 3 of the 5 patients, VPL nucleus of the thalamus was affected. Treatment strategies included varying combination of Levodopa/carbidopa, Clonazepam and Primidone with resulting minor improvements.
Conclusion: Post thalamic stroke MDs have a mixed phenomenology. On the basis of the clinical phenomenology at presentation, a fairly accurate anatomical and radiological correlation can be made.
References: 1. Ghika J, Bogousslavsky J, Henderson J, Maeder P, Regli F. The “jerky dystonic unsteady hand”: A delayed motor syndrome in posterior thalamic infarctions. J Neurol. 1994;241(9):537–42.
2. Gupta N, Pandey S. Post-Thalamic Stroke Movement Disorders: A Systematic Review. Eur Neurol. 2018;79(5–6):303–14.
To cite this abstract in AMA style:S. Garg, K. Shetty, C. H M, N. Sharma. Jerky dystonic hand revisited: post-stroke thalamic tremor [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/jerky-dystonic-hand-revisited-post-stroke-thalamic-tremor/. Accessed September 28, 2023.
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