Hyperkinetic movement disorders during and after acute stroke: The Lausanne Stroke Registry

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Abstract

Background and objective: To study consecutive patients with acute or delayed hyperkinetic movement disorders in the Lausanne Stroke Registry. Methods: We have identified 29 patients with acute or delayed movement disorders among 2500 patients who had their first-ever acute stroke in the Lausanne Stroke Registry. Setting: Department of Neurology, Lausanne University Hospital. Results: Our patients presented with hemichorea-hemiballism (11 patients), hemidystonia (5 patients), stereotypias (2 patients), jerky dystonic unsteady hand (3 patients), asterixis (2 patients), initial limb-shaking (2 patients), bilateral tremor (1 patients), bilateral jaw myoclonus (1 patient), hemiakathisia (1 patient) and dysarthria-dyskinetic hand (1 patieent). On neuroimaging a lesion was found in 25 of the 29 cases in the territory of the middle cerebral artery (7 deep, 2 superficial and 2 complete), the posterior cerebral artery (11 patients), both middle and posterior cerebral arteries (2 patients) or the anterior cerebral artery (1 patient). The jerky dystonic unsteady hand syndrome was associated with a specific lesion, an infarct in the territory of the posterior choroidal artery. Presumed small-vessel disease was the commonest cause of stroke (15 patients). Only 3 patients had persistent movements (> 6 months). Conclusion: Hyperkinetic movement disorders are uncommon in acute stroke (1 %), the commonest types being hemichorea-hemiballism and hemidystonia. These movement disorders are associated with stroke involving the basal ganglia and adjacent white matter in the territory of the middle or the posterior cerebral artery. The jerky dystonic unsteady hand syndrome is specifically associated with a small infarct in the territory of the posterior choroidal artery. The abnormal movements usually regress spontaneously. © 1997 Elsevier Science B.V. All rights reserved.

Introduction

Acute, paroxysmal, recurrent, transient, permanent and delayed abnormal movements have been reported in stroke. Most of these reports are isolated and a survey based on a large series of patients with movement disorders associated with stroke has been only reported recently (D'Olhaberriague et al., 1995). We here report the prevalence and clinical features of abnormal movements in patients admitted consecutively to the Lausanne Stroke Registry (LSR) Bogousslavsky et al., 1988bover 14 years.

Section snippets

Methods

We retrospectively reviewed all those patients included into the LSR (Bogousslavsky et al., 1988b) who developed hyperkinetic movement disorders during, or after acute stroke and patients who attended our Movement Disorders Unit or the outpatient facility of our hospital for delayed hyperkinetic movement disorders related to a previous cerebrovascular event. Not all patients with a previous acute stroke or hemorrhage had systematic follow-up in our outpatient unit, and therefore the prevalence

Results

We identified 15 women (mean age 73 years, range 60–90) and 14 men (mean age 67 years, range 32–84) among 2500 first stroke patients. The abnormal movements occurred on the right side in 16 patients, on the left side in 11, and on both sides in 2. On neuroimaging a focal lesion was found in 25 cases (86%). One patient had diffuse leukoaraiosis. No lesions were detected in 3 patients who only had CT, while all patients who had MRI showed a visible lesion. Two patients had a hemorrhage, 1 had a

Discussion

Hyperkinetic movement disorders are uncommon in acute stroke, with a prevalence of 292500 (1%) and an estimated incidence of 0.08% per year in our hospital-based study. Over the studied period, the total number of patients with subcortical ischemic or hemorrhagic involvement of a large portion of the basal ganglia without causing movement disorders was 536 out of the 2500 strokes of any etiology. This observation underlines the rare occurrence of movement disorders in the acute phase of stroke,

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