Pearls & Oy-sters: Resolution of hemichorea following endarterectomy for severe carotid stenosis

Abstract

We report three patients with hemichorea who were found to have contralateral atherosclerotic carotid artery stenosis. Their details are compared in the table. All patients had carotid duplex ultrasonography because they exhibited neurologic signs or symptoms suggestive of cerebrovascular ischemia in addition to chorea. View this table: Table Characteristics of the three cases Patient A developed right hemichorea; 9 months later she experienced three episodes of right limb weakness and speech disorder lasting 5 minutes, suggestive of transient ischemia. The severity of chorea increased and it mildly affected the left side. Neurologic examination revealed predominantly right-sided chorea and mild orofacial dyskinesia without other neurologic signs. The following blood tests were normal: full blood count, inflammatory markers, coagulation studies, renal, glucose, bone, liver, and thyroid biochemistry, immunoglobulin electrophoresis, anticardiolipin antibodies, and antinuclear antibodies screen (including extractable nuclear antigens). CT of the head was normal. Carotid duplex ultrasonography revealed 90% stenosis in the left internal carotid artery. Patient B developed right hemichorea and 3 months later expressive dysphasia and right facial and hand weakness; this precipitated admission. In addition to chorea, there was right visual inattention and upper motor neuron weakness affecting the right face and hand with normal reflexes and plantar responses. The same blood tests as for patient A were normal; in addition, treponemal serology was consistent with past infection. MRI of the brain showed a left-sided parietal lobe infarct which was limited to the gray matter of the posterior parietal lobe suggestive …