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Friedman-Korn T, Weill C, Ben-Haim S, Arkadir D. Delayed levodopa-responsive parkinsonism following acute midbrain injury. J Neurol Sci 2024; 459:122983. [PMID: 38574438 DOI: 10.1016/j.jns.2024.122983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
Acute midbrain injury may cause both hyperkinetic movement disorders and parkinsonism. The temporal interval between the insult and the emergence of hyperkinetic disorders can last years. A delayed appearance of parkinsonism, on the other hand, was rarely described. We present three cases of male patients (50-, 58- and 28-year-old) who developed levodopa-responsive parkinsonism 20, 8 and two years, respectively, after acute brain insult involving the midbrain. Insults included subcortical intracerebral hemorrhage dissecting into the midbrain, embolic basilar occlusion and trauma. A fluorodopa scan, performed in two cases, revealed reduced striatal uptake. All individuals improved on low doses of levodopa and developed motor fluctuations shortly after levodopa was introduced. We conclude that delayed, levodopa-responsive parkinsonism following midbrain injury should be recognized in the relevant clinical setup. Possible mechanisms include age-related loss of dopaminergic neurons superimposed on acute injury and secondary neurodegeneration.
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Affiliation(s)
- Tali Friedman-Korn
- Department of Neurology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
| | - Caroline Weill
- Department of Neurology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel; University College London, London, UK
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Mendes GNN, Braga Cruz Guedes de Morais A, Santos Ramos MM, Ferreira Frota NA, Maia Carvalho FM, Oliveira Lima F. Alajouanine-Akerman's sign due to a thalamic infarct. Rev Neurol (Paris) 2024:S0035-3787(24)00425-9. [PMID: 38458837 DOI: 10.1016/j.neurol.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/15/2023] [Accepted: 01/22/2024] [Indexed: 03/10/2024]
Affiliation(s)
- G N N Mendes
- Hospital Geral de Fortaleza (HGF), Fortaleza, Ceará, Brazil.
| | | | - M M Santos Ramos
- Hospital Universitário Walter Cantídio (HUWC), Fortaleza, Ceará, Brazil
| | - N A Ferreira Frota
- Hospital Geral de Fortaleza (HGF), Fortaleza, Ceará, Brazil; Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | - F M Maia Carvalho
- Hospital Geral de Fortaleza (HGF), Fortaleza, Ceará, Brazil; Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
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Hasegawa S, Tanaka T, Yamamoto S, Kashiwazaki D, Noguchi K, Kuroda S. Late-onset, first-ever involuntary movement after successful surgical revascularization for pediatric moyamoya disease - Report of two cases. Surg Neurol Int 2023; 14:430. [PMID: 38213430 PMCID: PMC10783671 DOI: 10.25259/sni_828_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
Background A small number of children with Moyamoya disease develop involuntary movements as an initial presentation at the onset, which usually resolves after effective surgical revascularization. However, involuntary movements that did not occur at the onset first occur after surgery in very rare cases. In this report, we describe two pediatric cases that developed involuntary movements during the stable postoperative period after successful surgical revascularization. Case Description A 10-year-old boy developed an ischemic stroke and successfully underwent combined bypass surgery. However, he developed chorea six months later. Another 8-year-old boy developed a transient ischemic attack and successfully underwent combined bypass surgery. However, he developed chorea three years later. In both cases, temporary use of haloperidol was quite effective in resolving the symptoms, and involuntary movements did not recur without any medication during follow-up periods of up to 10 years. Conclusion Postoperative first-ever involuntary movement is very rare in pediatric moyamoya disease, and the underlying mechanisms are still unclear, but a temporary, reversible imbalance of excitatory and inhibitory circuits in the basal ganglia may trigger the occurrence of these rare symptoms. Careful follow-up would be mandatory.
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Affiliation(s)
| | - Tomomi Tanaka
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | | | | | - Kyo Noguchi
- Department of Radiology, University of Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
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Almudhry M, Prasad AN, Rupar CA, Tay KY, Ratko S, Jenkins ME, Prasad C. A milder form of molybdenum cofactor deficiency type A presenting as Leigh's syndrome-like phenotype highlighting the secondary mitochondrial dysfunction: a case report. Front Neurol 2023; 14:1214137. [PMID: 37789894 PMCID: PMC10542394 DOI: 10.3389/fneur.2023.1214137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/18/2023] [Indexed: 10/05/2023] Open
Abstract
Background Molybdenum cofactor deficiency (MoCD) (OMIM# 252150) is an autosomal-recessive disorder caused by mutations in four genes involved in the molybdenum cofactor (MOCO) biosynthesis pathway. Objectives We report a milder phenotype in a patient with MOCS1 gene mutation who presented with a Leigh-like presentation. Case report We present the case of a 10-year-old boy who was symptomatic at the age of 5 months with sudden onset of dyskinesia, nystagmus, and extrapyramidal signs following a febrile illness. Initial biochemical, radiological, and histopathological findings a Leigh syndrome-like phenotype; however, whole-exome sequencing detected compound heterozygous mutations in MOCS1 gene, c.1133 G>C and c.217C>T, confirming an underlying MoCD. This was biochemically supported by low uric acid level of 80 (110-282 mmol/L) and low cystine level of 0 (3-49), and a urine S-sulfocysteine at 116 (0-15) mmol/mol creatinine. The patient was administered methionine- and cystine-free formulas. The patient has remained stable, with residual intellectual, speech, and motor sequelae. Conclusion This presentation expands the phenotypic variability of late-onset MoCD A and highlights the role of secondary mitochondrial dysfunction in its pathogenesis.
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Affiliation(s)
- Montaha Almudhry
- London Health Sciences Centre, London, ON, Canada
- Department of Neuroscience, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Asuri N. Prasad
- London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - C. Anthony Rupar
- London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
- Department of Biochemistry, Western University, London, ON, Canada
| | - Keng Yeow Tay
- London Health Sciences Centre, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
| | | | - Mary E. Jenkins
- London Health Sciences Centre, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Chitra Prasad
- London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
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Doumbouya I, Barry SD, Toure ML, Barry DN, Diawara K, Traoré M, Diallo MH, Cissé FA, Cissé A. Post-stroke Chorea in the Neurology Department of Ignace Deen Hospital of Conakry, Guinea. Cureus 2023; 15:e35515. [PMID: 37007400 PMCID: PMC10051035 DOI: 10.7759/cureus.35515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Chorea is an uncommon complication of stroke. The pathophysiology, the exact location of the lesions, and the evolution of this type of chorea are still poorly understood. The objective was to describe the epidemiological, clinical, and imaging profile of post-stroke chorea in a tropical environment in the context of a stroke epidemic. MATERIAL AND METHODS We conducted a five-year retrospective observational study from 2015 to 2020 on stroke patients who presented with chorea in our department. Epidemiological, clinical, and imaging data were registered. RESULTS Fourteen patients presented with chorea after their stroke, a frequency of 0.6%. The average age was 57.1 years with a male predominance. Hypertension was the cardiovascular risk factor in half of the patients; three patients (21.4) were diabetic. Chorea was the initial manifestation of the stroke in eight patients (57.1%). Thirteen patients (92.9%) had an ischaemic stroke and one had a cerebral haemorrhage. The middle cerebral artery (MCA) was involved in nine patients (64.3%), the anterior cerebral artery (ACA) in three patients (21.4%), and two patients (14.3%) had posterior cerebral artery (PCA) involvement. The lesions were cortical in five patients (35.7%), five other patients (35.7%) had a deep location, and four patients (28.6%) had both deep and cortical locations of their lesions. The structures affected were the lentiform nucleus (50%), the insula (35.7%), the caudate nucleus (14.3%), and the thalamus (14.3%). CONCLUSION Post-stroke chorea is poorly studied in the tropics. In the presence of any acute abnormal movement associated with cardiovascular risk factors, post-stroke chorea should be considered. Recovery is rapid when treated early.
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Hwang YS, Shin BS, Ryu HU, Kang HG. Monochorea after acute contralateral pontine infarction: A case report. Medicine (Baltimore) 2023; 102:e32660. [PMID: 36701735 PMCID: PMC9857559 DOI: 10.1097/md.0000000000032660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Chorea is a hyperkinetic movement characterized by random, brief, and involuntary muscle contractions. In stroke, a common cause of chorea, basal ganglia are anatomical locations that can cause chorea when a stroke occurs, and chorea is less frequently triggered by a stroke in other anatomical brain regions. Herein, we report a rare case of monochorea after acute contralateral pontine infarction. PATIENT CONCERNS A 32-year-old man visited the emergency room due to dysarthria and right hemiparesis that occurred approximately 6 hours and 30 minutes before the visit. A brain magnetic resonance image confirmed a diffusion restriction lesion in the left pons. The patient was initially diagnosed with acute infarction at the left pons and began to receive medical treatment with an antiplatelet agent and statin with admission. DIAGNOSIS Approximately 14 hours after the onset of the initial stroke symptoms, the patient complained of involuntary movement in the right arm for the first time. Intermittent, irregular involuntary movements were observed in the distal part of the right arm. This symptom was unpredictable and random, and a similar symptom was not observed in other parts of the patient's body. Clinically, post-stroke monochorea was suspected. INTERVENTIONS AND OUTCOMES The symptom improved from day 5 without specific medical treatment for chorea. LESSONS The monochorea caused by the pontine lesion in this case was triggered by the direct lesions of the corticospinal tract, and its underlying pathophysiology remains unclear. However, abnormal movements can occur due to inadequate downstream activation or inhibition of the corticospinal tract, which is induced by functional abnormalities of the motor cortex. This case suggests that further investigation is needed on the mechanisms of direct corticospinal tract lesions for chorea.
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Affiliation(s)
- Yun Su Hwang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Han Uk Ryu
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- * Correspondence: Hyun Goo Kang, Department of Neurology & Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeonbuk-do 54907, South Korea (e-mail: )
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Yen JM, Lim JH. A Clinical Perspective on Bespoke Sensing Mechanisms for Remote Monitoring and Rehabilitation of Neurological Diseases: Scoping Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:536. [PMID: 36617134 PMCID: PMC9823649 DOI: 10.3390/s23010536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
Neurological diseases including stroke and neurodegenerative disorders cause a hefty burden on the healthcare system. Survivors experience significant impairment in mobility and daily activities, which requires extensive rehabilitative interventions to assist them to regain lost skills and restore independence. The advent of remote rehabilitation architecture and enabling technology mandates the elaboration of sensing mechanisms tailored to individual clinical needs. This study aims to review current trends in the application of sensing mechanisms in remote monitoring and rehabilitation in neurological diseases, and to provide clinical insights to develop bespoke sensing mechanisms. A systematic search was performed using the PubMED database to identify 16 papers published for the period between 2018 to 2022. Teleceptive sensors (56%) were utilized more often than wearable proximate sensors (50%). The most commonly used modality was infrared (38%) and acceleration force (38%), followed by RGB color, EMG, light and temperature, and radio signal. The strategy adopted to improve the sensing mechanism included a multimodal sensor, the application of multiple sensors, sensor fusion, and machine learning. Most of the stroke studies utilized biofeedback control systems (78%) while the majority of studies for neurodegenerative disorders used sensors for remote monitoring (57%). Functional assessment tools that the sensing mechanism may emulate to produce clinically valid information were proposed and factors affecting user adoption were described. Lastly, the limitations and directions for further development were discussed.
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Affiliation(s)
- Jia Min Yen
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore 119074, Singapore
| | - Jeong Hoon Lim
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore 119074, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Pandey S, Joutsa J, Mehanna R, Shukla AW, Rodriguez‐Porcel F, Espay AJ. Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders. Mov Disord 2022; 37:1996-2007. [DOI: 10.1002/mds.29218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Institute of Postgraduate Medical Education and Research New Delhi India
- Department of Neurology, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad Delhi National Capital Region India
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Neurocenter Turku University Hospital Turku Finland
| | - Raja Mehanna
- UT Move, Department of Neurology University of Texas Health Science Center at Houston‐McGovern Medical School Houston Texas USA
| | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases University of Florida Gainesville Florida USA
| | | | - Alberto J. Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders University of Cincinnati Academic Health Center Cincinnati Ohio USA
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Ion I, Parvu T, Farouil G, Sablot D. Hemiballism-hemichorea revealing carotidal stenosis. Rev Neurol (Paris) 2022; 178:859-861. [PMID: 35868870 DOI: 10.1016/j.neurol.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/08/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- I Ion
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - T Parvu
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - G Farouil
- Department of Interventional Neuroradiology, Service of Radiology, CH Perpignan, Perpignan, France.
| | - D Sablot
- Department of Neurology, CH Perpignan, Perpignan, France.
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Park KW, Choi N, Oh E, Lyoo CH, Baek MS, Kim HJ, Yoo D, Lee JY, Choi JH, Lee JH, Koh SB, Sung YH, Cho JW, Yang HJ, Park J, Shin HW, Ahn TB, Ryu HS, You S, Choi SM, Kim BJ, Lee SH, Chung SJ. Movement Disorders Associated With Cerebral Artery Stenosis: A Nationwide Study. Front Neurol 2022; 13:939823. [PMID: 35911886 PMCID: PMC9330487 DOI: 10.3389/fneur.2022.939823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Studies of secondary movement disorder (MD) caused by cerebrovascular diseases have primarily focused on post-stroke MD. However, MD can also result from cerebral artery stenosis (CAS) without clinical manifestations of stroke. In this study, we aimed to investigate the clinical characteristics of MD associated with CAS. Materials and Methods A nationwide multicenter retrospective analysis was performed based on the data from patients with CAS-associated MDs from 16 MD specialized clinics in South Korea, available between January 1999 and September 2019. CAS was defined as the >50% luminal stenosis of the major cerebral arteries. The association between MD and CAS was determined by MD specialists using pre-defined clinical criteria. The collected clinical information included baseline demographics, features of MD, characteristics of CAS, treatment, and MD outcomes. Statistical analyses were performed to identify factors associated with the MD outcomes. Results The data from a total of 81 patients with CAS-associated MD were analyzed. The mean age of MD onset was 60.5 ± 19.7 years. Chorea was the most common MD (57%), followed by tremor/limb-shaking, myoclonus, and dystonia. Atherosclerosis was the most common etiology of CAS (78%), with the remaining cases attributed to moyamoya disease (MMD). Relative to patients with atherosclerosis, those with MMD developed MD at a younger age (p < 0.001) and had a more chronic mode of onset (p = 0.001) and less acute ischemic lesion (p = 0.021). Eight patients who underwent surgical treatment for CAS showed positive outcomes. Patients with acute MD onset had a better outcome than those with subacute-to-chronic MD onset (p = 0.008). Conclusions This study highlights the spectrum of CAS-associated with MD across the country. A progressive, age-dependent functional neuronal modulation in the basal ganglia due to CAS may underlie this condition.
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Affiliation(s)
- Kye Won Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Nari Choi
- Department of Neurology, Heavenly Hospital, Goyang, South Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Seok Baek
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Han-Joon Kim
- Department of Neurology, Movement Disorder Center, College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dalla Yoo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College, Seoul, South Korea
| | - Ji-Hyun Choi
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College, Seoul, South Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea
| | - Young Hee Sung
- Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Sooyeoun You
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Sun Ju Chung
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Revert Barberà A, Estragués Gazquez I, Beltrán Mármol M, Rodríguez Campello A. Bilateral chorea as a manifestation of cerebral venous sinus thrombosis associated with COVID-19. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:507-509. [PMID: 35534388 PMCID: PMC9076026 DOI: 10.1016/j.nrleng.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/13/2021] [Indexed: 10/29/2022] Open
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Barberà AR, Gazquez IE, Mármol MBB, Campello AR. [Bilateral chorea as a manifestation of cerebral venous sinus thrombosis associated with COVID-19]. Neurologia 2021; 37:507-509. [PMID: 34840380 PMCID: PMC8604661 DOI: 10.1016/j.nrl.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anna Revert Barberà
- Unidad de Ictus. Servicio de Neurología, Hospital del Mar, Barcelona, España
| | | | | | - Ana Rodríguez Campello
- Unidad de Ictus. Servicio de Neurología, Hospital del Mar, Barcelona, España.,Grupo de investigación Neurovascular. IMIM (Instituto Hospital del Mar de Investigaciones médicas), Barcelona, España.,Universitat Autònoma de Barcelona-UAB, Facultat de Medicina, Barcelona, España
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13
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Roman Casul YA, Humbert ML, Farooqui A, Wagle Shukla A, Nagaraja N. Dystonia as a Presenting Feature of Acute Ischemic Stroke: A Case Report and Literature Review. Cureus 2021; 13:e17272. [PMID: 34540493 PMCID: PMC8448260 DOI: 10.7759/cureus.17272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
Hypokinetic and hyperkinetic movement disorders can occur post-stroke. Of these, dystonia is known to occur in the chronic stage of stroke. Rarely, acute dystonia can present as a symptom of acute ischemic stroke or develop during hospitalization for ischemic stroke. In this article, we present a case of acute focal dystonia as a presenting symptom of acute ischemic stroke, review the literature to summarize previous reports, and provide more insight into the pathophysiologic mechanisms related to this presentation.
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Affiliation(s)
- Yoram A Roman Casul
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Meghan L Humbert
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Amreen Farooqui
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Aparna Wagle Shukla
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, USA
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Li ZS, Fang JJ, Xiang XH, Zhao GH. Hemichorea due to ipsilateral thalamic infarction: A case report. World J Clin Cases 2021; 9:5287-5293. [PMID: 34307580 PMCID: PMC8283608 DOI: 10.12998/wjcc.v9.i19.5287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemichorea usually results from vascular lesions of the basal ganglia. Most often, the lesion is contralateral to the affected limb but rarely, it may be ipsilateral. The pathophysiology of ipsilateral hemichorea is still poorly understood. We review the literature on hemichorea due to ipsilateral cerebral infarction and explore possible mechanisms for its occurrence.
CASE SUMMARY A 72-year-old woman presented with complaints of involuntary movements of the muscles of the left side of the face and mild weakness of the right limbs. Her symptoms had started suddenly 1 d earlier. After admission to the hospital, the involuntary movements spread to involve the left limbs also. Magnetic resonance imaging revealed a left thalamic infarction. The patient’s hemichorea subsided after treatment with haloperidol (2 mg per time, 3 times/d) for 3 d; the hemiparesis resolved with rehabilitation physiotherapy. She is presently symptom free and on treatment for prevention of secondary stroke. We review the literature on the occurrence of ipsilateral hemichorea following thalamic infarction and discuss the possible pathomechanisms of this unusual presentation.
CONCLUSION Ipsilateral hemichorea following a thalamic stroke is rare but it can be explained by structure of the extrapyramidal system. The thalamus is a relay station that exerts a bilateral control of motor function.
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Affiliation(s)
- Zhao-Sheng Li
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Jia-Jia Fang
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Xiao-Hui Xiang
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
| | - Guo-Hua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
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15
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Adeagbo CA, Olawale OA, Gbiri CAO. Transcranial direct current stimulation and repetitive functional task-oriented programme for upper limb functional rehabilitation in stroke survivors. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1945805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Caleb Adewumi Adeagbo
- Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
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16
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Tater P, Pandey S. Post-stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management. Neurol India 2021; 69:272-283. [PMID: 33904435 DOI: 10.4103/0028-3886.314574] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Involuntary movements develop after 1-4% of strokes and they have been reported in patients with ischemic and hemorrhagic strokes affecting the basal ganglia, thalamus, and/or their connections. Hemichorea-hemiballism is the most common movement disorder following a stroke in adults while dystonia is most common in children. Tremor, myoclonus, asterixis, stereotypies, and vascular parkinsonism are other movement disorders seen following stroke. Some of them occur immediately after acute stroke, some can develop later, and others may have delayed onset progressive course. Proposed pathophysiological mechanisms include neuronal plasticity, functional diaschisis, and age-related differences in brain metabolism. There are no guidelines regarding the management of post-stroke movement disorders, mainly because of their heterogeneity.
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Affiliation(s)
- Priyanka Tater
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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17
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Mannion J, Tariq S, Owens P. Transient bilateral chorea secondary to digoxin toxicity in a female with acute kidney injury: a case report. Eur Heart J Case Rep 2021; 5:ytab022. [PMID: 33569535 PMCID: PMC7859595 DOI: 10.1093/ehjcr/ytab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/17/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022]
Abstract
Background Chorea secondary to digoxin toxicity is rare, with only three published cases describing the phenomenon. We report the case of a 78-year-old female presenting with intermittent vomiting and diarrhoea for 4 weeks. She had a history of chronic kidney disease and digoxin use for atrial fibrillation. Case summary A 78-year-old lady presented to the emergency department with a 4-week history of intermittent vomiting and diarrhoea. These symptoms commenced after a course of antibiotics prescribed by her general practitioner for a urinary tract infection. Her admission electrocardiogram demonstrated atrial fibrillation at a rate of 32, with evidence of digitalis toxicity. Her creatinine was 396 µmol/L (44–80 µmol/L) with digoxin level 8.1 nmol/L (0.77–1.5 nmol/L). Initially, treatment was with digoxin-specific antibody (FAB) and fluid resuscitation. Within 24 h, she developed transient head, neck, and bilateral upper limb chorea. Review of medications revealed no other likely causative agent. Neuroimaging showed no new ischaemia, but stable established bilateral infarcts of the basal ganglia. Haloperidol 0.5 mg twice daily was commenced. Three days later as digoxin levels normalized, the chorea resolved entirely without recurrence. Discussion We have identified three reported cases of digoxin-induced chorea. Our case resembles two of the published cases where a transient bilateral chorea, associated with digitalis toxicity and resolving within a few days of normalization of digoxin levels was demonstrated. There were no other focal neurological signs or symptoms. It has been postulated that an alteration to dopaminergic neuronal activity is a potential mechanism, as digoxin also demonstrates neuropsychiatric side effects such as psychosis and depression.
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Affiliation(s)
- James Mannion
- Cardiology Department, University Hospital Waterford, Waterford, Ireland
| | - Samreen Tariq
- Cardiology Department, University Hospital Waterford, Waterford, Ireland
| | - Patrick Owens
- Cardiology Department, University Hospital Waterford, Waterford, Ireland
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18
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Wang X, Huang X, Yang M, Pan X, Duan M, Cai H, Jiang G, Wen X, Zou D, Chen L. Tongxinluo promotes axonal plasticity and functional recovery after stroke. Transl Neurosci 2020; 11:428-438. [PMID: 33335781 PMCID: PMC7718613 DOI: 10.1515/tnsci-2020-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to investigate the neural plasticity in contralesional cortex and the effects of tongxinluo (TXL) in cerebral ischemic rats. Methodology We used stroke-prone renovascular hypertensive (RHRSP) cerebral ischemia rat models to study the effect of TXL and the underlying mechanisms. We performed foot-fault and beam-walking tests to evaluate the motor function of rats after cortical infarction. Biotinylated dextran amine (BDA) was used to track axonal sprouting and neural connections. Results TXL enhanced the recovery of motor function in cerebral infarction rats. TXL increased axonal sprouting in the peri-infarcted area but not in the corpus callosum, indicating in situ origination instead of crossing between cortical hemispheres through the corpus callosum. TXL promoted the sprouting of corticospinal axons into the denervated side of spinal gray matter. The synaptophysin (SYN)-positive intensity in the peri-infarcted area of TXL-treated group was greater than that in the vehicle group. We observed co-localization of SYN with BDA-positive fibers in the denervated spinal cord gray matter in the TXL group, suggesting that axonal remodeling and synaptic connections were promoted by TXL. Conclusion TXL may promote the recovery of neurological function by promoting the axonal remodeling and synapse formation of motor neuronal fibers after focal cortical infarction in hypertensive rats.
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Affiliation(s)
- Xiaoting Wang
- Department of Neurology, Wuzhou Red Cross Hospital, Wuzhou, Guangxi Zhuang Autonomous Region, 543002, China
| | - Xiaoqin Huang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Mengqi Yang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Xueying Pan
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Meiyi Duan
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Hui Cai
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Guimiao Jiang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Xianlong Wen
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Donghua Zou
- Department of Neurology, the Fifth Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Li Chen
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- Guangxi Key Laboratory of Regenerative Medicine and Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
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19
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Biswas T, Gudi S, Sane R. Acute hemiballismus in the absence of subthalamic nucleus lesion. MGM JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mgmj.mgmj_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Ufoaroh C, Agah O, Morah N, Anyabolu E. Hemiballismus in subcortical lacunar infarcts. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_111_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Spellicy SE, Kaiser EE, Bowler MM, Jurgielewicz BJ, Webb RL, West FD, Stice SL. Neural Stem Cell Extracellular Vesicles Disrupt Midline Shift Predictive Outcomes in Porcine Ischemic Stroke Model. Transl Stroke Res 2019; 11:776-788. [PMID: 31811639 PMCID: PMC7340639 DOI: 10.1007/s12975-019-00753-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance imaging (MRI) is a clinically relevant non-invasive imaging tool commonly utilized to assess stroke progression in real time. This study investigated the utility of MRI as a predictive measure of clinical and functional outcomes when a stroke intervention is withheld or provided, in order to identify biomarkers for stroke functional outcome under these conditions. Fifteen MRI and ninety functional parameters were measured in a middle cerebral artery occlusion (MCAO) porcine ischemic stroke model. Multiparametric analysis of correlations between MRI measurements and functional outcome was conducted. Acute axial and coronal midline shift (MLS) at 24 h post-stroke were associated with decreased survival and recovery measured by modified Rankin scale (mRS) and were significantly correlated with 52 measured acute (day 1 post) and chronic (day 84 post) gait and behavior impairments in non-treated stroked animals. These results suggest that MLS may be an important non-invasive biomarker that can be used to predict patient outcomes and prognosis as well as guide therapeutic intervention and rehabilitation in non-treated animals and potentially human patients that do not receive interventional treatments. Neural stem cell–derived extracellular vesicle (NSC EV) was a disruptive therapy because NSC EV administration post-stroke disrupted MLS correlations observed in non-treated stroked animals. MLS was not associated with survival and functional outcomes in NSC EV–treated animals. In contrast to untreated animals, NSC EVs improved stroked animal outcomes regardless of MLS severity.
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Affiliation(s)
- Samantha E Spellicy
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Erin E Kaiser
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Michael M Bowler
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
| | - Brian J Jurgielewicz
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | | | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Steven L Stice
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA.
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA.
- ArunA Biomedical, Athens, GA, 30602, USA.
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22
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Forman CR, Svane C, Kruuse C, Gracies JM, Nielsen JB, Lorentzen J. Sustained involuntary muscle activity in cerebral palsy and stroke: same symptom, diverse mechanisms. Brain Commun 2019; 1:fcz037. [PMID: 33033798 PMCID: PMC7531180 DOI: 10.1093/braincomms/fcz037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022] Open
Abstract
Individuals with lesions of central motor pathways frequently suffer from sustained
involuntary muscle activity. This symptom shares clinical characteristics with dystonia
but is observable in individuals classified as spastic. The term spastic dystonia has been
introduced, although the underlying mechanisms of involuntary activity are not clarified
and vary between individuals depending on the disorder. This study aimed to investigate
the nature and pathophysiology of sustained involuntary muscle activity in adults with
cerebral palsy and stroke. Seventeen adults with cerebral palsy (Gross Motor Function
Classification System I–V), 8 adults with chronic stroke and 14 control individuals
participated in the study. All individuals with cerebral palsy or stroke showed increased
resistance to passive movement with Modified Ashworth Scale >1. Two-minute surface EMG
recordings were obtained from the biceps muscle during attempted rest in three positions
of the elbow joint; a maximally flexed position, a 90-degree position and a maximally
extended position. Cross-correlation analysis of sustained involuntary muscle activity
from individuals with cerebral palsy and stroke, and recordings of voluntary isometric
contractions from control individuals were performed to examine common synaptic drive. In
total, 13 out of 17 individuals with cerebral palsy and all 8 individuals with stroke
contained sustained involuntary muscle activity. In individuals with cerebral palsy, the
level of muscle activity was not affected by the joint position. In individuals with
stroke, the level of muscle activity significantly (P < 0.05)
increased from the flexed position to the 90 degree and extended position. Cumulant
density function indicated significant short-term synchronization of motor unit activities
in all recordings. All groups exhibited significant coherence in the alpha (6–15 Hz), beta
(16–35 Hz) and early gamma band (36–60 Hz). The cerebral palsy group had lower alpha band
coherence estimates, but higher gamma band coherence estimates compared with the stroke
group. Individuals with increased resistance to passive movement due to cerebral palsy or
stroke frequently suffer sustained involuntary muscle activity, which cannot exclusively
be described by spasticity. The sustained involuntary muscle activity in both groups
originated from a common synaptic input to the motor neuron pool, but the generating
mechanisms could differ between groups. In cerebral palsy it seemed to originate more from
central mechanisms, whereas peripheral mechanisms likely play a larger role in stroke. The
sustained involuntary muscle activity should not be treated simply like the spinal stretch
reflex mediated symptom of spasticity and should not either be treated identically in both
groups.
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Affiliation(s)
| | - Christian Svane
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, 2730 Herlev Gentofte, Denmark
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est Creteil, Hospital Albert Chenevier-Henri Mondor, Service de Rééducation Neurolocomotrice, APHP, Créteil, France
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.,Elsass Institute, 2830 Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.,Elsass Institute, 2830 Charlottenlund, Denmark
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Chandradevan R, Rutkofsky IH, Lynn B, Kitchen FL, Simmons ML. Acute Post-stroke Hemiparkinsonism and Hemiparesis: A Unique Case with Successful Therapy. Cureus 2019; 11:e4950. [PMID: 31453024 PMCID: PMC6701904 DOI: 10.7759/cureus.4950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of a new onset movement disorder after a stroke has important clinical implications. The early assessment and timely diagnosis of post-stroke disorders is essential for influencing long-term outcomes. Localizing lesions and determining the underlying etiology is vital in targeting appropriate therapy. New and sudden onset of hemiparkinsonism with hemiparesis, rigidity, and tremor following an acute ischemic stroke is described here. This presentation was clinically diagnosed as acute post-stroke parkinsonism (APSP). The patient’s level of impairment was significant enough to compromise his activities of daily living (ADL), physical therapy (PT), and occupational therapy (OT) in an inpatient rehabilitation center. In the inpatient rehabilitation center, the patient received a trial of levodopa for suspected APSP. After levodopa therapy was initiated, we observed an improvement of his parkinsonian features with a sustained response and reached the conclusion that the clinical recognition of post-stroke parkinsonism treated with a targeted trial with levodopa may improve the quality of life. Proper treatment of APSP has the potential to provide the best opportunity for recovery and positively influence the long-term outcomes in similar patients.
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Affiliation(s)
| | | | - Bryan Lynn
- Internal Medicine, Mercer University, Macon, USA
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24
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Manso-Calderón R. Clinical Features and Treatment in the Spectrum of Paroxysmal Dyskinesias: An Observational Study in South-West Castilla y Leon, Spain. Neurol Res Int 2019; 2019:4191796. [PMID: 31186958 PMCID: PMC6521303 DOI: 10.1155/2019/4191796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Paroxysmal dyskinesias (PxD) are a group of heterogeneous disorders characterized by intermittent episodes of involuntary movements. PxD include paroxysmal kinesigenic (PKD), nonkinesigenic (PNK), and exercise-induced (PED) varieties. OBJECTIVES To define the phenotype of primary and secondary PxD forms. METHODS Twenty-two patients with PxD (9 men/13 women) were evaluated in two hospitals in south-west Castilla y Leon, Spain. Clinical features of the episodes, causes, family history, and response to treatment were collected. RESULTS Thirteen participants with primary PxD (6 men/7 women) and 9 with secondary PxD (3 men/6 women) were recruited. Nine patients belong to three nonrelated families (2 had PKD and 1 had PED). Mean age at onset in primary PKD cases was 10 years (range 5-23 years), earlier than in PNKD (24 years) and PED (20 years). Most primary PKD cases experienced daily episodes of duration <1 minute, which are more frequent and shorter attacks than in PNKD (1-2 per month, 5 minutes) and PED (1 per day, 15 minutes). The location of the involuntary movements varied widely; isolated dystonia was more common than mixed chorea and dystonia. All PKD patients who received antiepileptic treatment significantly improved. Levodopa and ketogenic diet proved to be effective in two patients with PED. Secondary forms presented a later mean age of onset (51 years). Six cases had PNKD, 1 had PKD, 1 both PNKD and PKD, and 1 had PED. Causes comprised vascular lesions, encephalitis, multiple sclerosis, peripheral trauma, endocrinopathies, and drugs such as selective serotonin reuptake inhibitors (SSRIs). CONCLUSION The knowledge of the clinical features and spectrum of causes related to PxD is crucial to avoid delays in diagnosis and treatment, or even a nonorganic disorder diagnosis.
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Affiliation(s)
- Raquel Manso-Calderón
- Department of Neurology, University Hospital of Salamanca, 37007 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
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25
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Udagedara TB, Dhananjalee Alahakoon AM, Goonaratna IK. Vascular Parkinsonism: A Review on Management updates. Ann Indian Acad Neurol 2019; 22:17-20. [PMID: 30692754 PMCID: PMC6327701 DOI: 10.4103/aian.aian_194_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
"Vascular parkinsonism (VP)" is a condition which presents with the clinical features of parkinsonism that are presumably caused by cerebrovascular disease. It is classically described as symmetrical lower-body parkinsonism with gait unsteadiness and absence of tremors and is usually associated with pyramidal signs. Treatment for VP remains challenging as available data on the efficacy of current treatment options are contentious. VP is generally considered to be poorly responsive to levodopa, the most effective of the current treatment modalities for parkinsonism. However, there is evidence that some patients benefit from therapy with levodopa. This article reviews the place of levodopa in the treatment of VP.
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26
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Gower A, Tiberi M. The Intersection of Central Dopamine System and Stroke: Potential Avenues Aiming at Enhancement of Motor Recovery. Front Synaptic Neurosci 2018; 10:18. [PMID: 30034335 PMCID: PMC6043669 DOI: 10.3389/fnsyn.2018.00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
Dopamine, a major neurotransmitter, plays a role in a wide range of brain sensorimotor functions. Parkinson's disease and schizophrenia are two major human neuropsychiatric disorders typically associated with dysfunctional dopamine activity levels, which can be alleviated through the druggability of the dopaminergic systems. Meanwhile, several studies suggest that optimal brain dopamine activity levels are also significantly impacted in other serious neurological conditions, notably stroke, but this has yet to be fully appreciated at both basic and clinical research levels. This is of utmost importance as there is a need for better treatments to improve recovery from stroke. Here, we discuss the state of knowledge regarding the modulation of dopaminergic systems following stroke, and the use of dopamine boosting therapies in animal stroke models to improve stroke recovery. Indeed, studies in animals and humans show stroke leads to changes in dopamine functioning. Moreover, evidence from animal stroke models suggests stimulation of dopamine receptors may be a promising therapeutic approach for enhancing motor recovery from stroke. With respect to the latter, we discuss the evidence for several possible receptor-linked mechanisms by which improved motor recovery may be mediated. One avenue of particular promise is the subtype-selective stimulation of dopamine receptors in conjunction with physical therapy. However, results from clinical trials so far have been more mixed due to a number of potential reasons including, targeting of the wrong patient populations and use of drugs which modulate a wide array of receptors. Notwithstanding these issues, it is hoped that future research endeavors will assist in the development of more refined dopaminergic therapeutic approaches to enhance stroke recovery.
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Affiliation(s)
- Annette Gower
- Ottawa Hospital Research Institute (Neuroscience Program), Ottawa, ON, Canada.,University of Ottawa Brain and Mind Institute, Ottawa, ON, Canada.,Departments of Medicine, Cellular and Molecular Medicine, and Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Mario Tiberi
- Ottawa Hospital Research Institute (Neuroscience Program), Ottawa, ON, Canada.,University of Ottawa Brain and Mind Institute, Ottawa, ON, Canada.,Departments of Medicine, Cellular and Molecular Medicine, and Psychiatry, University of Ottawa, Ottawa, ON, Canada
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Lee SI, Jung HT, Park J, Jeong J, Ryu T, Kim Y, Santos VSD, Miranda JGV, Daneault JF. Towards the Ambulatory Assessment of Movement Quality in Stroke Survivors using a Wrist-worn Inertial Sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2825-2828. [PMID: 30440989 DOI: 10.1109/embc.2018.8512845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stroke is a leading cause of long-term disability that may lead to significant functional motor impairments in the upper limb (UL). Wrist-worn inertial sensors have emerged as an objective, minimally-obtrusive tool to monitor UL motor function in the real-world setting, such that rehabilitation interventions can be individually tailored to maximize functional performance. However, current wearable solutions focus on capturing the quantity of movement without considering the quality of movement. This paper introduces a novel approach to unobtrusively estimate the quality of UL movements in stroke survivors using a single wrist-worn inertial sensor during any type of voluntary UL movements. The proposed method exploits kinematic characteristics of voluntary limb movements that are optimized by the central nervous system during motor control. This work demonstrates that the proposed method could extract clinically important information during random UL movements in 16 stroke survivors, showing a statistically significant correlation to the Functional Ability Scale - a clinically validated score for movement quality.
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28
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Udagedara TB, Gooneratne IK. Jaw tremor: a manifestation of vascular parkinsonism? - a case report. BMC Neurol 2018; 18:92. [PMID: 29960586 PMCID: PMC6026506 DOI: 10.1186/s12883-018-1093-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 06/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background Vascular Parkinsonism (VP) is a heterogeneous group of conditions that manifest clinically in parkinsonian features, but are presumably of vascular cause. It is usually bilateral, non-tremulous, and frequently associated with pyramidal signs. Classically VP is described as lower body parkinsonism affecting predominantly the legs. Case presentation A 67 years old lady presented with a history of acute onset jaw tremor, with tremor predominantly in both upper limbs. Neurological examination revealed hypomimia of the face with cogwheel rigidity and bradykinesia bilaterally, predominantly in the upper limbs without pyramidal signs. She had a marked tremor of the jaw at rest. When she was asked to open her mouth the tremor was re-emergent. Non contrast CT scan of her brain revealed an infarction in the region of putamen on the left with no evidence of diffuse subcortical white matter ischemia or extension to the caudate nucleus. She was treated with levodopa and responded well to medication. Conclusions This case describes atypical clinical features which could be associated with VP including jaw tremor. This case also stresses the importance of initiating a trial of levodopa as certain patients may respond well to medication. Electronic supplementary material The online version of this article (10.1186/s12883-018-1093-5) contains supplementary material, which is available to authorized users.
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29
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Vercelli S, Ferriero G, Bravini E, Al Yazeedi W, Salgovic L, Caligari M, Sartorio F. A simple orthosis solves a problem in a patient with a dystonic finger after stroke. J Hand Ther 2017; 30:113-115. [PMID: 27894678 DOI: 10.1016/j.jht.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/16/2016] [Indexed: 02/03/2023]
Abstract
These authors use a custom-fabricated orthotic device to improve hand motion and function for a client with hand dystonia after stroke. Clinical observation and reasoning resulted in an effective solution to control the dystonia that was acceptable to the client. - Kristin Valdes, OTD, OT, CHT, Practice Forum Editor.
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Affiliation(s)
- Stefano Vercelli
- Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Division of Physical Medicine and Rehabilitation, Salvatore, Maugeri Foundation - IRCCS, Scientific Institute of Veruno, Novara, Italy.
| | - Giorgio Ferriero
- Department of Physical Medicine & Rehabilitation, Hamad Medical Corporation, Doha, Qatar
| | - Elisabetta Bravini
- School in Advanced Sciences and Technology in Rehabilitation Medicine and Sport, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Wafa Al Yazeedi
- Department of Physical Medicine & Rehabilitation, Hamad Medical Corporation, Doha, Qatar
| | | | - Marco Caligari
- Division of Physical Medicine and Rehabilitation, Salvatore Maugeri Foundation - IRCCS, Scientific Institute of Veruno, Novara, Italy
| | - Francesco Sartorio
- Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Division of Physical Medicine and Rehabilitation, Salvatore, Maugeri Foundation - IRCCS, Scientific Institute of Veruno, Novara, Italy
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30
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Carolei A, Modesti PA. Limb-shaking TIA: on the borders of evidence-based medicine. Intern Emerg Med 2017; 12:675-677. [PMID: 28432542 DOI: 10.1007/s11739-017-1666-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Antonio Carolei
- Department of Applied Clinical Sciences and Biotechnology University of L'Aquila, L'Aquila, Italy
| | - Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Lin CI, Lin YC, Lien WC, Hsieh PC, Lin SH, Kuan TS. Punding following posterior cerebral artery infarction: a case report and literature review. Neuropsychiatr Dis Treat 2017; 13:981-985. [PMID: 28408832 PMCID: PMC5384735 DOI: 10.2147/ndt.s132775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Punding is a complex stereotyped behavior, characterized by excessiveness, non-goal orientation, and repetitiveness. It is mostly associated with Parkinson's disease, and very few cases in non-Parkinson's disease have been reported. We report a case of punding associated with supratentorial ischemic stroke. CASE PRESENTATION We present a 70-year-old man with left posterior cerebral artery infarction with quetiapine-induced punding manifesting as repetitive unidirectional body turning. Remission of punding behavior ensued after cessation of quetiapine and administration of clonazepam. CONCLUSION This case describes the clinical course of quetiapine-induced punding in a patient with left posterior cerebral artery infarction. It suggests clonazepam may serve as a treatment option for poststroke punding.
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Affiliation(s)
- Cho-I Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Han Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Abstract
Objective Psychosomatic medicine psychiatrists are often tasked with the evaluation and treatment of complex neuropsychiatric states which may be motoric in phenotype. Little energy has been dedicated to understanding acute movement disorders in the hospital environment. Method Recognizing the importance of frontal-subcortical (corticostriatothalamocortical) circuitry and basal ganglia structures, we present a case series of acute movement disorder phenotypes resulting from underlying medical conditions, commonly-administered medications, or the interaction of both. We organize these scenarios into neurodegenerative disorders, primary psychiatric disorders, neuroinflammation, and polypharmacy, demonstrating a clinical example of each followed by background references on a variety of clinical states and medications contributing to acute movement disorders. In addition, we offer visual illustration of implicated neurocircuitry as well as proposed neurotransmitter imbalances involving glutamate, gamma aminobutyric acid, and dopamine. Furthermore, we review the various clinical syndromes and medications involved in the development of acute movement disorders. Results Acute movement disorder's involve complex interactions between frontal-subcortical circuits and acute events. Given the complexity of interactions, psychopharmacological considerations become critical, as some treatments may alleviate acute movement disorders while others will exacerbate them. Conclusion Integrating underlying medical conditions and acutely administered (or discontinued) pharmacological agents offers an interactional, neuromedical approach to acute movement disorders that is critical to the work of psychosomatic medicine.
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Affiliation(s)
- Ifrah Zawar
- 1 Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mario A Caro
- 2 Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lara Feldman
- 2 Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Xavier F Jimenez
- 2 Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA.,3 Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kwon DY. Movement Disorders Following Cerebrovascular Lesions: Etiology, Treatment Options and Prognosis. J Mov Disord 2016; 9:63-70. [PMID: 27240807 PMCID: PMC4886206 DOI: 10.14802/jmd.16008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 02/23/2016] [Accepted: 03/07/2016] [Indexed: 12/15/2022] Open
Abstract
Post-stroke movement disorders are uncommon, but comprise an important part of secondary movement disorders. These exert variable and heterogeneous clinical courses according to the stroke lesion and its temporal relationships. Moreover, the predominant stroke symptoms hinder a proper diagnosis in clinical practice. This article describes the etiology, treatment options and prognosis of post-stroke movement disorders.
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Affiliation(s)
- Do-Young Kwon
- Department of Neurology, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
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Park J. Movement Disorders Following Cerebrovascular Lesion in the Basal Ganglia Circuit. J Mov Disord 2016; 9:71-9. [PMID: 27240808 PMCID: PMC4886205 DOI: 10.14802/jmd.16005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/02/2016] [Accepted: 04/12/2016] [Indexed: 12/11/2022] Open
Abstract
Movement disorders are primarily associated with the basal ganglia and the thalamus; therefore, movement disorders are more frequently manifest after stroke compared with neurological injuries associated with other structures of the brain. Overall clinical features, such as types of movement disorder, the time of onset and prognosis, are similar with movement disorders after stroke in other structures. Dystonia and chorea are commonly occurring post-stroke movement disorders in basal ganglia circuit, and these disorders rarely present with tremor. Rarer movement disorders, including tic, restless leg syndrome, and blepharospasm, can also develop following a stroke. Although the precise mechanisms underlying the pathogenesis of these conditions have not been fully characterized, disruptions in the crosstalk between the inhibitory and excitatory circuits resulting from vascular insult are proposed to be the underlying cause. The GABA (gamma-aminobutyric acid)ergic and dopaminergic systems play key roles in post-stroke movement disorders. This review summarizes movement disorders induced by basal ganglia and thalamic stroke according to the anatomical regions in which they manifest.
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Affiliation(s)
- Jinse Park
- Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea
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Pandey S, Sarma N, Jain S. Thumb Tremor in Acute Cortical Infarct. Mov Disord Clin Pract 2016; 3:515-517. [PMID: 30713940 DOI: 10.1002/mdc3.12320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/01/2015] [Accepted: 12/16/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
| | - Neelav Sarma
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
| | - Shruti Jain
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
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