Alternating Paroxysmal Hemiballism-Hemichorea in Bilateral Internal Carotid Artery Stenosis

• Published in: Internal Medicine Vol. 40; no. 8; pp. 808 - 812
• Main Authors: SHIMIZU, Toshio, HIROKI, Masahiko, YAMAOKA, Yumiko, KATO, Shuichi, SUDA, Minami, IDE, Katsuhisa, YAGISHITA, Akira, HIRAI, Shunsaku
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 2001; Japanese Society of Internal Medicine
• Subjects: Aged; Angiography; Biological and medical sciences; Carotid Artery, Internal - pathology; Carotid Artery, Internal - surgery; carotid endarterectomy; Carotid Stenosis - complications; Carotid Stenosis - surgery; Chorea - diagnosis; Chorea - etiology; Dyskinesias - diagnosis; Dyskinesias - etiology; Electromyography; Endarterectomy, Carotid; Humans; Investigative techniques, diagnostic techniques (general aspects); limb shaking; Magnetic Resonance Imaging; Male; Medical sciences; Nervous system; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Tomography, Emission-Computed, Single-Photon; transient ischemic attack; Human; Alternance; Nervous system diseases; Internal carotid; Radiodiagnosis; Chorea; Stenosis; Cardiovascular disease; Bilateral; Nuclear magnetic resonance imaging; Cerebral disorder; Involuntary movement; Arterial disease; Vascular disease; Case study; Central nervous system disease; Hemiballismus; Medical imagery; Complication; Neurological disorder; Elderly; Cerebrovascular disease; Extrapyramidal syndrome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.40.808

A 72-year-old man presented with paroxysmal and transient involuntary movements, or "limb shaking". The attacks occurred alternately from one side of the body to the other and ceased spontaneously. Surface EMG study showed synchronous grouping discharges in multiple limb muscles, being compatible with hemiballism-hemichorea. Cerebral angiography demonstrated marked stenosis of the bilateral internal carotid arteries. Bilateral carotid endarterectomy led to complete disappearance of the involuntary movements. Alternating paroxysmal hemiballismhemichorea might be a transient ischemic attack, and alternating striatal dysfunction induced by cerebral hemodynamic or microembolic ischemia probably plays a central role in the occurrence of such involuntary movements. (Internal Medicine 40: 808-812, 2001)