Session Information
Date: Wednesday, June 7, 2017
Session Title: Choreas (Non-Huntington’s Disease)
Session Time: 1:15pm-2:45pm
Location: Exhibit Hall C
Objective: To investigate the metabolic pattern of acute hemichorea associated with contralateral carotid artery stenosis and no lesion on structural brain imaging, using brain 18F-FDG-PET.
Background: Previous reports have suggested that acute hemichorea may be caused by high grade carotid stenosis in the absence of basal ganglia (BG) stroke. The hypothesis is that hemichorea arise as a consequence of functional changes in the BG due to reversible hemodynamic ischemia. However, the casual association between carotid artery disease and contralateral hemichorea remains controversial. The pathophysiology of this association is poorly investigated.
Methods: Using 18F-FDG-PET brain imaging we studied three patients with acute hemichorea and normal brain MRI in whom contralateral subtotal internal carotid artery stenosis was found on the ultrasound examination. Patients were studied before and after resolution of carotid stenosis. As controls, we studied three patients with acute hemichorea but without contralateral carotid artery stenosis and two patients with high degree carotid stenosis but no hemichorea.
Results: All three patients with acute hemichorea , high degree of contralateral carotid stenosis and no MRI lesion to account for their clinical symptoms were found to have hyperactivity of basal ganglia on the side of the stenosis ( contralateral to hemichorea) on 18F-FDG-PET. In two of these patients 18F-FDG-PET was repeated after intervention (carotid artery surgery and carotid artery stenting ). In both patients, significant decrease of BG activity was noted in parallel with clinical improvement. Three patients with acute hemichorea but without contralateral carotid stenosis had either decreased activity in BG contralateral to hemichorea ( 1 patient) or normal BG activity ( 2 patients) . Finally, 18F-FDG-PET in two patients with high degree carotid artery stenosis but no hemichorea showed normal BG activity.
Conclusions: There may be an association between acute hemichorea, high degree contralateral carotid artery stenosis and hyperactivity of BG on the side of the stenosis. Our findings suggest that revascularization procedures may normalize blood flow in the BG, lowering 18F-FDG-PET activity and improving the symptoms of hemichorea.
To cite this abstract in AMA style:
L. Savsek, A. Andlovic, N. Ozimic, L. Jensterle, P. Tomse, M. Grmek, J. Pretnar Oblak, Z. Pirtosek, M. Trost, M. Kojovic. Metabolic pattern of acute hemichorea associated with contralateral carotid stenosis [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/metabolic-pattern-of-acute-hemichorea-associated-with-contralateral-carotid-stenosis/. Accessed May 18, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/metabolic-pattern-of-acute-hemichorea-associated-with-contralateral-carotid-stenosis/