Hemichorea-Hemiballism: Clinical Study of 13 Patients

Abstract

Purpose Hemichorea-hemiballism (HCHB) is an uncommon involuntary movement that designates a unilateral uncontrollable, poorly patterned flinging movement of limb at variable amplitude. Our aim of this review is for further etiology recognition and its correlated neuroimaging study in patients with HCHB. Methods We retrospectively studied the records of thirteen patients with HCHB obtained during a period of 2 years (five men and eight women) with ages ranged from 40 to 89 years (mean age 69 ± 11.36 years). Seven patients underwent only brain CT, four patients only with brain MR images and two patients underwent both brain CT and MR images. Results Seven patients had hyperglycemia secondary to diabetes mellitus and six patients had stroke. Among the patients with hyperglycemia, the average blood sugar at the onset was 392.21mg/dl, two patients were found with increase attenuation change at basal ganglia via brain CT, three of them revealed hyperintense lesion at putamen, caudate nucleus and globus pallidus on T1-weighted brain MR images, two showed no evidence of brain lesion on brain CT. Two patients of stroke had basal ganglia infarction, one had thalamus infarction, one had multiple infarction at frontal and corona radiata on brain MR image; one had caudate nucleus infarction, and one with no lesion on brain CT. One of thirteen patients had spontaneous remission in days, four of them had resolution after neuroleptic drugs treatment in days to a month, one patient had symptoms recurrence 10 months after the first attack, the remaining patients had intermittent hemiballistic movement with treatment at out-patient clinic. Conclusion Hyperglycemia secondary to diabetes mellitus and stroke remain as the major causes of HCHB. Seven patients had lesions of basal ganglia and two patients had lesion outside the basal ganglia. The prognosis of HCHB is benign but variable in resolution time. Most of the patients required days to months for symptoms resolution under the neuroleptic agent.