Kawahara Ichiro, Ishizaka Shunsuke, Yagi Nobuhiro, Nakamoto Morito, Matsuo Yoshitaka, Tokunaga Yoshiharu
Department of Neurosurgery, Nagasaki Prefectural Shimabara Hospital, 7895 Shimokawashiri-town, Shimabara-shi, Nagasaki 855-0861, Japan.
No Shinkei Geka. 2008 Dec;36(12):1139-44.
Ballism is characterized by continuous, coarse, flinging involuntary movements involving the limbs. Although persistent involuntary movements caused by cerebrovascular diseases mostly in middle-aged patients are well known, transient involuntary movements are an unusual manifestation of cerebrovascular diseases. We describe a rare case of reversible ischemic neurologic deficit (RIND) presented as hemiballism. A 71-year-old man was admitted to our hospital for hemiballism in the right limbs. On magnetic resonance (MR) imagings, there was no evidence of acute ischemic stroke, but MR angiography revealed severe stenosis of left middle cerebral artery. Electroencephalogram showed no epileptic discharge. For hemiballism, chlorpromazine and haloperidol were administered in addition to antiplatelet management for ischemic attack, and the patient completely recovered on the 5 days of hospitalization. Transient ischemic attacks (TIA) or RIND typically present with neurological deficits such as loss of muscle power, reduced sensation, or visual loss. Involuntary movements are not generally regarded to be TIA or RIND. Involuntary movements such as hemiballism, however, can occur as a symptom of TIA or RIND, which should be recognized and differentiated from conditions like partial seizures. Moreover, they may be an indicator of severe carotid stenotic or occlusive diseases, and patients may be at high risk of ischemic events. Early diagnosis and timely treatment are required to prevent ischemic events.
偏身投掷症的特点是肢体出现持续、粗大、抛掷样的不自主运动。虽然由脑血管疾病引起的持续性不自主运动在中年患者中较为常见，但短暂性不自主运动是脑血管疾病的一种不寻常表现。我们描述了一例罕见的以偏身投掷症为表现的可逆性缺血性神经功能缺损（RIND）病例。一名71岁男性因右肢偏身投掷症入住我院。磁共振成像（MR）检查未发现急性缺血性卒中的证据，但磁共振血管造影显示左大脑中动脉严重狭窄。脑电图显示无癫痫放电。针对偏身投掷症，除了对缺血性发作进行抗血小板治疗外，还给予了氯丙嗪和氟哌啶醇，患者在住院第5天时完全康复。短暂性脑缺血发作（TIA）或RIND通常表现为神经功能缺损，如肌力丧失、感觉减退或视力丧失。不自主运动一般不被认为是TIA或RIND。然而，像偏身投掷症这样的不自主运动可能作为TIA或RIND的症状出现，应予以识别并与部分癫痫等疾病相鉴别。此外，它们可能是严重颈动脉狭窄或闭塞性疾病的一个指标，患者可能有发生缺血性事件的高风险。需要早期诊断和及时治疗以预防缺血性事件。
