Yoshikawa M, Yamamoto M, Shibata K, Ohta K, Kamite Y, Takahashi M, Shimizu Y, Ohba S, Kuwabara S, Uozumi T
Department of Neurosurgery, Matsue Red Cross Hospital, Japan.
Neurol Med Chir (Tokyo). 1992 Sep;32(10):769-72. doi: 10.2176/nmc.32.769.
Left-sided hemichorea developed suddenly in a 73-year-old male. Computed tomography revealed a left subdural hematoma (SDH) and infarction in the right corona radiata and temporo-occipital region. Hemichorea subsided completely after removal of the SDH. Postoperative single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime revealed a global low-perfusion area in the right cerebral hemisphere. Right carotid angiography demonstrated severe stenosis of the trunk of the right middle cerebral artery. The cerebral blood flow in the right cerebral hemisphere had probably already decreased to nearly the critical level and was reduced further by the left SDH, inducing the left-sided hemichorea due to dysfunction of the right cerebral hemisphere. This case shows that when hemichorea ipsilateral to a SDH is present, it is important to ascertain whether there is a pre-existing ischemic lesion in the contralateral cerebral hemisphere, particularly in the basal ganglia, thalamus, or corona radiata.
一名73岁男性突然出现左侧偏身舞蹈症。计算机断层扫描显示左侧硬膜下血肿（SDH）以及右侧放射冠和颞枕叶区域梗死。清除SDH后，偏身舞蹈症完全消退。术后用锝-99m-六甲基丙烯胺肟进行单光子发射计算机断层扫描显示右侧大脑半球存在整体低灌注区。右侧颈动脉血管造影显示右侧大脑中动脉主干严重狭窄。右侧大脑半球的脑血流量可能已经降至接近临界水平，并因左侧SDH而进一步减少，导致右侧大脑半球功能障碍，进而引发左侧偏身舞蹈症。该病例表明，当存在与SDH同侧的偏身舞蹈症时，确定对侧大脑半球，尤其是基底节、丘脑或放射冠是否存在先前存在的缺血性病变非常重要。
