Hemlballismus, as you know, is a rare disorder in which violent, uncontrollable movements of one arm and leg occur. The term hemiballismus, credited to Kussmaul by Oppenheim, is reserved for those cases in which the movements are massive, violent, flinging movements of one extremity or one half of the body. Walker 17 stated that hemiballismus probably should be considered a variety of choreo-athetosis. These involuntary actions may begin at times with little more than flinging of an article from the hand, but soon reach such dramatic violence that the patient may be thrown from the bed by them. The flingings and hurlings of the extremities usually persist through every waking moment. Although the movements disappear with sleep, sleep is usually impossible even with heavy sedation. The patient becomes distraught and eventually exhausted 9 by the violent constant movements and usually dies of pneumonia or cardiac failure in a few days to 5 weeks. Greiff 5 in 1883 was the first to localize the lesion to the contralateral corpus subthalamicum. This was forgotten until Bonhocffer t in 1897, Jakob in 19~3 and Martin 1~ in 19~7 revcrified the pathology to be in the contralateral subthalamic nucleus of Luys. Moersch and Kernohan 13 in 1939 reported a case. Whittier 18 in 1947 was able to find 30 cases with adequate pathological studies of the subthalamic nucleus. In 6 of these the subthalamic nucleus was intact, but it was presumed that its connections were interrupted. In 4 cases no change was noted in the nucleus or its connections. Meyers et al. 12 believed that the lesion may arise in different areas of a neural circuit rather than be confined to the nucleus of Luys. In the majority of instances, the lesion is vascular, either hemorrhage or thrombosis, although occasional cases of neoplastic involvement have been reported. Hampel 6 stated that the blood supply of the subthalamic nucleus is derived from three arterics--a branch of posterior cerebral, a choroidal artery and a branch of the posterior communicating. Carpenter 4 felt that the primary blood supply is from branches of the posterior cerebral artery. The Vogts had expressed the belief that a topical relationship existed in the subthalamic nucleus. In the cases reviewed by Whittier 18 the oral pole was destroyed in 17, with the face being involved. Meyers et al. 1~ have felt that there is a somatotopic localization in the nucleus with rostral lesions causing movement of the head and neck, lesions of the middle portion affecting the upper extremity and the caudal portion involving the lower extremity. Herz and Meyers ~ proposed a theory for the pathogenesis of hemiballismus in which impulses of the kinetic circuit flow from the periphery to the thalamus and are passed on to the postcentral areas 1, ~, 3--then by U-fibers to the motor area 4 and 4Y and premotor area 6 (Fig. 1).
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