Movement disorders in cerebrovascular disease
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA. The Lancet Neurology
(Impact Factor: 21.9).
04/2013; 12(6). DOI: 10.1016/S1474-4422(13)70057-7
Movement disorders can occur as primary (idiopathic) or genetic disease, as a manifestation of an underlying neurodegenerative disorder, or secondary to a wide range of neurological or systemic diseases. Cerebrovascular diseases represent up to 22% of secondary movement disorders, and involuntary movements develop after 1-4% of strokes. Post-stroke movement disorders can manifest in parkinsonism or a wide range of hyperkinetic movement disorders including chorea, ballism, athetosis, dystonia, tremor, myoclonus, stereotypies, and akathisia. Some of these disorders occur immediately after acute stroke, whereas others can develop later, and yet others represent delayed-onset progressive movement disorders. These movement disorders have been encountered in patients with ischaemic and haemorrhagic strokes, subarachnoid haemorrhage, cerebrovascular malformations, and dural arteriovenous fistula affecting the basal ganglia, their connections, or both.
Available from: Paolo Solla
- "Parkinsonism with acute/subacute onset is uncommon and other conditions, different from a neurodegenerative process, should be considered in differential diagnosis. In this context , cerebrovascular diseases are considered among these possible causes of parkinsonism, representing up to 22% of secondary movement disorders . In this regard, mesencephalic infarcts have been related to parkinsonism , often with rapid onset, and dopamine transporter SPECT has been highly recommended to confirm or exclude nigrostriatal dopaminergic degeneration . "
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ABSTRACT: Cerebrovascular diseases are considered among possible causes of acute/subacute parkinsonism, representing up to 22% of secondary movement disorders. In cases of suspected vascular parkinsonism (VP), dopamine transporter SPECT has been highly recommended to exclude nigrostriatal dopaminergic degeneration. We report the case of a hemiparkinsonism related to a left midbrain infarct with focal lateralized putaminal abnormalities at
I-FP-CIT SPECT imaging. The asymmetric uptake at dopamine transporter SPECT was different to findings commonly observed in typical PD pattern, because the ipsilateral striatum, in opposite to idiopathic PD, showed normal tracer binding. However, this selective parkinsonism after infarction of the midbrain was responsive to levodopa. In conclusion, we retain that there is a need of more functional imaging studies in VP addressed to a more consistent classification of its different clinical forms and to a better understanding of the adequate pharmacological management.
Available from: degruyter.com
- "Furthermore, as PM is a type of segmental myoclonus, clonazepam and sodium valproate are most frequently used to treat myoclonus . "
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ABSTRACT: Background: Palatal myoclonus (PM) is the hallmark of hypertrophic olivary degeneration (HOD); however, little
is known regarding the association of thalamic lesions and PM. Case presentation: Here, we report a case of
deteriorative PM after an acute small ventrolateral thalamic hemorrhage in a female Chinese patient with HOD.
The sudden and severe deterioration of PM was preceded by at least 10 days of an occasionally occurring PM,
which was related to an acute cerebellar hemorrhage 8 months earlier. A computed tomography scan upon
admission showed a small intracerebral hematoma in the left ventrolateral thalamus, and a magnetic resonance
imaging scan revealed the typical signs of HOD as well as a remote lesion in the dentate nucleus. Symptoms of
PM were controlled by carbamazepine and clonazepam. Conclusion: These findings indicated that the damaged
dentatothalamic tract might be due to a unique pathogenic mechanism involving a lesion of the ventrolateral
thalamus and Guillain-Mollaret triangle.
- "Movement disorders (MD) can be classified as “primary,” which are a manifestation of an underlying neurodegenerative disorder, or “secondary” to a wide range of neurological or systemic diseases. Various etiological factors have been described causing secondary MDs (SMDs) such as cerebrovascular disease, space occupying lesions, trauma and infections. Netravathi et al. in their study had reported infectious causes representing up to 20.4% of all SMDs. MDs secondary to infectious causes are diverse ranging from hypokinetic disorders such as parkinsonism (PAR) to hyperkinetic disorders such as chorea, dystonia, tics, tremor and myoclonus (MYO). "
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ABSTRACT: Background:Movement disorders (MDs) associated with infections remains an important debilitating disorder in the Asian countries.Objectives:The objective of the following study is to report the clinical and imaging profile of a large cohort of patients with MDs probably associated with infection.Materials and Methods:This was a chart review of 35 patients (F:M-15:20) presenting with MD in the Neurology services of National Institute of Mental Health and Neurosciences, India. The demographic profile, type of infection, time from infection to MD, phenomenology of MD and magnetic resonance imaging (MRI) findings were reviewed.Results:The mean age at presentation was 22.6 ± 13.3 years, (5-60), age of onset of MD was 15.7 ± 15 years, and duration of symptoms was 6.9 ± 8.1 years (42 days to 32 years). The mean latency of onset of MD after the infection was 5.9 ± 4.2 weeks. The phenomenology of MD were: (1) Pure dystonia-28.6%, (2) dystonia with choreoathetosis-22.9%, (3) Parkinsonism-14.6%, (4) pure tremor, hemiballismus, myoclonus and chorea-2.9% each, and (5) mixed MD-22.9%. Most often the MD was generalized (60%), followed by right upper limb (31.4%) and left upper limb (8.6%). A viral encephalitic type of neuroinfection was the most common infection (85.7%), which was associated with MD. Abnormalities of brain MRI, seen in 79.2%, included signal changes in (1) thalamus-52.0%, (2) putamen and subcortical white matter-16% each, (3) pons-12%, (4) striatopallidum, striatum and grey matter-8% each, and (5) caudate, cerebellum, lentiform nucleus, midbrain and subthalamic nucleus-4.0% each.Conclusions:MDs associated with infection were the most often post-encephalitic. Dystonia was the most common MD, and thalamus was the most common anatomical site involved.
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