Kato Hiroyuki, Murakami Takenobu, Tajiri Yuki, Yamaguchi Noriya, Ugawa Yoshikazu, Hanajima Ritsuko
Department of Neurology, Tottori Prefectural Kousei Hospital.
Department of Internal medicine, NichinanTown National Health Insurance Nichinan Hospital.
Rinsho Shinkeigaku. 2021 May 19;61(5):325-328. doi: 10.5692/clinicalneurol.cn-001527. Epub 2021 Apr 17.
A 86-year-old woman with left hemiparesis was admitted to our hospital. When visiting to our hospital, hemichorea appeared on her left extremities in an ambulance. She also had mild disturbance of consciousness, spatial disorientation, and sensory disturbance. Blood biochemical studies revealed mild renal failure. DWI MRI showed hyperintensities in the postcentral gyrus and a posterior part of the insula in the right hemisphere, but no signal changes in FLAIR. No lesions were detected in the basal ganglia. The DWI-FLAIR mismatch suggested acute cerebral infarction, and we performed intravenous thrombolysis therapy. Her neurological symptoms including hemichorea gradually improved, and she was finally discharged on foot. Two conspicuous points of the present patient are the sensory cortical infarction and an association with renal failure. In this patient, the sensory cortical infarction must produce chorea even though sensory cortical lesions rarely caused chorea. The associated renal dysfunction may play some role in the production of chorea. The double-crash of cerebral infarction and metabolic abnormality (renal dysfunction) may cause hemichorea which is rarely seen in patients with cerebral infarction of the sensory cortex and insula with no metabolic abnormalities.
一名86岁左侧偏瘫女性入住我院。来我院就诊时，在救护车上其左上肢出现偏身舞蹈症。她还伴有轻度意识障碍、空间定向障碍和感觉障碍。血液生化检查显示轻度肾衰竭。弥散加权成像（DWI）磁共振成像（MRI）显示右侧半球中央后回及岛叶后部高信号，但液体衰减反转恢复序列（FLAIR）无信号改变。基底节未发现病变。DWI-FLAIR不匹配提示急性脑梗死，我们进行了静脉溶栓治疗。她包括偏身舞蹈症在内的神经症状逐渐改善，最终步行出院。该患者有两个显著特点，即感觉皮层梗死及与肾衰竭相关。在该患者中，感觉皮层梗死必定导致舞蹈症，尽管感觉皮层病变很少引起舞蹈症。相关的肾功能不全可能在舞蹈症的发生中起一定作用。脑梗死与代谢异常（肾功能不全）的双重打击可能导致偏身舞蹈症，这在无代谢异常的感觉皮层和岛叶脑梗死患者中很少见。
