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Neurology
Unilateral hemichorea and hemiballismus in a woman in her late 70s
  1. Tharuka Milinda Herath1,
  2. Faraaz Ahmed2,
  3. May Saleh3 and
  4. Kannan Nithi2
  1. 1Neurology, Kettering General Hospital, Kettering, UK
  2. 2Neurology, Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
  3. 3Kettering General Hospital NHS Foundation Trust, Kettering, UK
  1. Correspondence to Dr Tharuka Milinda Herath; tharukaherath11{at}gmail.com

Abstract

Chorea is a hyperkinetic movement disorder characterised by involuntary, brief, random and irregular contractions. Acquired chorea can present acutely or subacutely and may be asymmetrical or unilateral. A detailed history and examination are crucial to identify triggering factors and underlying cause. In this case, a woman in her late 70s presented with progressively increasing involuntary movements in her right upper and lower limbs, triggered by active movements but ceasing with rest. Her medical history included a transient ischaemic attack (TIA) 3 years prior. Examination revealed choreoathetoid movements on the right side, occasionally manifesting as ballismus, which disappeared with rest. MRI showed small areas of restricted diffusion in the left parietal lobe suggestive of a microbleed, and carotid duplex ultrasonography revealed significant stenosis in the left carotid artery. The differential diagnosis included secondary paroxysmal kinesigenic dyskinesia and limb-shaking TIA/haemodynamic factors. In this report, we discuss both these differentials and how to approach.

  • Neurology
  • Movement disorders (other than Parkinsons)
  • Stroke

https://doi.org/10.1136/bcr-2024-262688

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: TMH, FA, MS and KN. The following authors gave final approval of the manuscript: TMH, FA, MS and KN. TMH accepts full responsibility for the finished work, had access to the data and controlled the decision to publish and is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.