Post-stroke hemiballismus: a series of two cases

Abstract

Background. Hemiballismus is a rare hyperkinetic movement disorder characterized by irregular, poorly patterned, high amplitude involuntary movements of the limbs on one side of the body. While being usually a consequence of subthalamic nucleus lesions, hemiballismus is uncommonly associated with stroke in adults. Moreover, many debates remain regarding the physiopathology behind post-stroke hemiballismus and its optimal treatment. Case reports. In this context, the article aims to present two intriguing cases of hemiballismus arising from ischemic stroke, illustrating the intricate interplay between vascular pathology and movement disorders. Case 1 involves a 72-year-old female presenting with sudden onset left hemiballismus following incomplete right middle cerebral artery infarction, who received intravenous thrombolysis and had a good outcome. Case 2, an 80-year-old female presenting with abrupt onset right hemiballismus, with a suboptimal therapeutic response but self-remission after three months. Considering the inconclusive imaging results, this case highlights the diagnostic challenges and dilemmas encountered in the management of post-stroke hemiballismus. Conclusions. The authors propose a discussion by comparing the selected case reports with currently available data from the literature, focusing on the diagnosis and possible therapeutic strategies. These two cases underscore the importance of early recognition and tailored management of post-stroke hemiballismus, enriching the understanding of this movement disorder.