Pearls & Oy-sters: Resolution of hemichorea following endarterectomy for severe carotid stenosis

Neurology Department, Wessex Neurosciences Centre, Mailpoint 101, Level B, Southampton University Hospital Trust, Tremona Road, Southampton SO16 6YD, UK.
Neurology (Impact Factor: 8.29). 01/2009; 71(24):e80-2. DOI: 10.1212/01.wnl.0000336975.80810.74
Source: PubMed
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    • "Hemichorea is a very rare presentation of carotid occlusive disease to cause hemodynamic compromise in watershed territories. In searching the literature, we have found several reports of acute hemichorea or hemiballism associated with carotid artery occlusive disease.4–9 However, these hyperkinetic movement disorders seem to be related to ischemic lesions in the basal ganglia or subthalamic nucleus in the majority of patients. "
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    ABSTRACT: Involuntary movement associated with deep watershed ischemic lesions has been rarely reported. A 67-year-old woman presented with acute hemichorea on the left side. Magnetic resonance imaging showed acute infarcts in the anterior border zone. On perfusion studies, impaired cerebral blood flow was observed on the subcortical region sparing the basal ganglia. Cerebral angiogram confirmed severe stenosis in the right internal carotid artery. Her hemichorea gradually improved along with normalization of perfusion after carotid artery stenting with angioplasty. We suggest that impaired cerebral blood flow in critical watershed territories may be an important contributing factor in hemichorea associated with carotid occlusive disease.
    05/2013; 6(1):17-20. DOI:10.14802/jmd.13004
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    • "Chorea has a wide differential diagnosis including infections, autoimmune diseases, genetic and neurodegenerative disorders, drug-exposure, metabolic diseases, neoplasm and stroke [1]. So far, only a recent report has suggested that carotid artery stenosis should be considered in the differential diagnosis of chorea, even in the absence of a preceding stroke or transient ischemic attack [2]. Interestingly, few reports have suggested that impaired cerebral blood flow in basal ganglia is a key contributing factor. "
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    ABSTRACT: Hemichorea associated with carotid artery occlusive disease is extremely rare. It has been recently suggested that carotid artery stenosis should be considered in the differential diagnosis of chorea, even in the absence of a preceding stroke or transient ischemic attack. Although the pathophysiology of this condition is still under discussion, some reports suggest that impaired cerebral blood flow in the basal ganglia is a key contributing factor. We herein report a case of hemichorea related to severe stenosis of the left internal carotid artery with no basal ganglia lesions on brain MRI. After carotid revascularization, hemichorea gradually subsided and reversible left thalamic and putaminal hypoperfusion were demonstrated by functional neuroimaging. This case report supports the hypothesis about the central role of hemodynamic ischemia in the pathophysiology of hemichorea associated with carotid artery stenosis, and highlights the importance of vascular imaging studies for the early identification of carotid disease in patients with chorea, even in the absence of other clinical signs.
    Journal of the neurological sciences 09/2010; 300(1-2):185-6. DOI:10.1016/j.jns.2010.08.068 · 2.47 Impact Factor
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    ABSTRACT: 2009;12(1): 30-34 ÖZET Hemikore serebrovasküler hastalıklarda nadir görülen bir bulgu olup, genellikle karşı taraf bazal gangliyon, talamus ve korona radiyatada iskemik lezyonları sonucu ortaya çıkar. Ciddi karotis arter stenozuna bağlı serebral hipoperfüzyon ile hemikore oluşması ise oldukça nadirdir. Vasküler nedenli hemikore olgularının tedavisi ve prognozu da belirsizdir. Bu sunumda geçici iskemik atakları ve internal karotis arterinde ciddi darlığı olan, akut hemikore gelişmiş bir olgunun karotis arter stent anjiyoplastisi sonrası düzeldiğini bildirilmektedir. Anahtar Kelimeler: Kore, karotis arter, stent, anjiyoplasti SUMMARY Hemichorea is a rare symptom of cerebrovascular diseases and occasionally occurs as a result of ischemic lesions of the basal ganglia, thalamus and corona radiata. As a cause of hemichorea, cerebral hypoperfusion due to severe carotid artery stenosis is very rare. The treatment and the prognosis of hemichorea due to vascular etiology are also unclear. In this paper we report resolution of hemichorea in a patient with transient ischemic attacks and severe carotid artery stenosis after the angioplasty and stenting procedure of the carotid artery.
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