Objective:

To describe the case of a patient with acute chorea and ballistic movement disorder due to intracerebral hemorrhage in subthalamic nucleus.

Background: Chorea and ballistic movement disorder is one the neurological symptom of subthalamic nucleus lesion due to neurologic diseases. The hallmark of subthalamic lesion is high amplitude, unrhythmic, involuntary ballistic involuntary movement involving the proximal part of contralateral extremities.

Method: Case Report

Results: A 61 year old man was admitted to the stroke unit due to intracerebral hemorrhage in the left subthalamic nucleus. Brain CT has revealed a small hematoma in the left subthalamic nucleus. 5-6 days later after  admitted patient had developed right sided ballistic and chorea like movement in the proximal part of extremities. Sometimes involuntary movement has mixed severe continues dystonic contracture of affected limbs and continues irritability after light stimuli leading to severely disabling patients in bed. To avoid fall from bed, the patient’s affected limb was fixed in bed for a while.  Hyperkinesia was  poorly responded to neuroleptics Haldol 3 mg per day during 3-4  days and increased to 5 mg with moderate effect. After discharging, the patient was taken Haldol 2,5 mg per day for one month until ameliorating hyperkinesia.

Conclusion:

Ballistic movement disorders in general are common presenting features of subthalamic lesions of the brain. We described severely disabling and intensive  chorea, ballistic and dystonic movement disorder in contralateral extremities due to small sized hematoma in subthalamic nucleus. The precise care was needed with severe and intensive hyperkinesia due to stroke.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/severe-chorea-ballistic-and-dystonic-movement-disorder-due-to-intracerebral-hemorrhage-in-subthalamic-nucleus/