Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea.
Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
Medicine (Baltimore). 2023 Jan 20;102(3):e32660. doi: 10.1097/MD.0000000000032660.
Chorea is a hyperkinetic movement characterized by random, brief, and involuntary muscle contractions. In stroke, a common cause of chorea, basal ganglia are anatomical locations that can cause chorea when a stroke occurs, and chorea is less frequently triggered by a stroke in other anatomical brain regions. Herein, we report a rare case of monochorea after acute contralateral pontine infarction.
A 32-year-old man visited the emergency room due to dysarthria and right hemiparesis that occurred approximately 6 hours and 30 minutes before the visit. A brain magnetic resonance image confirmed a diffusion restriction lesion in the left pons. The patient was initially diagnosed with acute infarction at the left pons and began to receive medical treatment with an antiplatelet agent and statin with admission.
Approximately 14 hours after the onset of the initial stroke symptoms, the patient complained of involuntary movement in the right arm for the first time. Intermittent, irregular involuntary movements were observed in the distal part of the right arm. This symptom was unpredictable and random, and a similar symptom was not observed in other parts of the patient's body. Clinically, post-stroke monochorea was suspected.
The symptom improved from day 5 without specific medical treatment for chorea.
The monochorea caused by the pontine lesion in this case was triggered by the direct lesions of the corticospinal tract, and its underlying pathophysiology remains unclear. However, abnormal movements can occur due to inadequate downstream activation or inhibition of the corticospinal tract, which is induced by functional abnormalities of the motor cortex. This case suggests that further investigation is needed on the mechanisms of direct corticospinal tract lesions for chorea.
舞蹈症是一种以随机、短暂和无意识肌肉收缩为特征的运动障碍。在中风中，基底节是一种常见的舞蹈症病因，当中风发生时，基底节可以引起舞蹈症，而在其他解剖脑区中风较少引发舞蹈症。在此，我们报告一例急性对侧脑桥梗死后出现的单一舞蹈症病例。
一名 32 岁男性因构音障碍和右侧偏瘫就诊，症状发生在就诊前约 6 小时 30 分钟。头颅磁共振成像证实左侧脑桥存在弥散受限病变。患者最初被诊断为左侧脑桥急性梗死，并于入院时开始接受抗血小板药物和他汀类药物治疗。
在首次中风症状发作后约 14 小时，患者首次出现右臂不由自主运动。观察到右侧手臂远端间歇性、不规则的不自主运动。该症状不可预测且随机，且未在患者身体其他部位观察到类似症状。临床上怀疑为中风后单一舞蹈症。
在没有针对舞蹈症的特定治疗的情况下，症状从第 5 天开始改善。
本例中由脑桥病变引起的单一舞蹈症是由皮质脊髓束的直接病变引起的，其潜在的病理生理学机制尚不清楚。然而，由于运动皮质的功能异常导致皮质脊髓束下游的激活或抑制不足，可能会出现异常运动。该病例提示需要进一步研究直接皮质脊髓束病变引起舞蹈症的机制。
