Resolution of Stroke-Related Hemichorea-Hemiballismus with Haloperidol

Abstract

Hemichorea-hemiballismus (HC-HB) is a hyperkinetic disorder characterized by violent, unilateral jerking movements which usually improve to choreoathetosis with time. Etiology of HC-HB has been demonstrated in case reports and series, with acute stroke being one of the known etiologies. Among the rare post-stroke hyperkinetic syndromes, HC-HB is the most common. However, there is limited data on management and long term follow up of this debilitating condition when related to acute stroke. Here we describe a 79-year-old gentleman with acute caudate stroke, with resulting HC-HB, whose symptoms were managed with haloperidol while hospitalized. Resolution of HC-HB and subsequent discontinuation of haloperidol yielded an optimal patient outcome. Long term follow-up for this patient has demonstrated lack of symptom recurrence at 1 year. This case further supports the use of neuroleptics such as haloperidol as first line for management of HC-HB.