Israelyan Arman, Ludlow John, Pyatka Nataliya, Durant Edward J
Department of Emergency, Kaiser Permanente Central Valley, Modesto, CA, USA.
Department of Neurology, Kaiser Permanente Central Valley, Modesto, CA, USA.
Am J Case Rep. 2024 Mar 4;25:e941840. doi: 10.12659/AJCR.941840.
BACKGROUND Hemiballismus is the most severe form of chorea and is a hyperkinetic disorder characterized by involuntary, high-amplitude movements of the ipsilateral arm and leg, due to lesions of the contralateral side of the central nervous system. Ischemic or hemorrhagic strokes and nonketotic hyperglycemia are predominant etiologies of hemiballismus. Case reports highlighting hemiballismus associated with temporal and parietal lobe infarcts have been published, although research of frontal lobe involvement is limited. CASE REPORT A 78-year-old woman presented to the Emergency Department with sudden-onset left-sided hemiballismus. On examination, she was alert, oriented to self and time, and able to follow commands. Her neurologic examination was notable for left-sided hemiballismus, described by the provider as periodic, uncontrolled, and involving a "flinging" motion of the left upper and lower extremities, sparing the face. She was treated with benzodiazepines in the Emergency Department and administered intravenous levetiracetam. Computed tomography of the head without contrast revealed an old left basal ganglia lacunar infarct. The patient was then admitted to the inpatient service, where magnetic resonance imaging of the brain revealed an acute punctate left superior frontal gyrus cortical infarct. Outpatient electroencephalogram revealed right anterior hemisphere dysfunction. CONCLUSIONS We describe a patient with left-sided sudden onset hemiballismus with an acute infarct of the ipsilateral superior frontal gyrus. This case highlights that brain lesions separate from the basal ganglia can induce hemiballismus, particularly within the frontal lobe, which warrants further research into precentral sulcus functioning and its role in modulating motor activity.
偏身投掷症是最严重的舞蹈病形式，是一种运动亢进性疾病，其特征为中枢神经系统对侧病变导致同侧手臂和腿部出现不自主的大幅度运动。缺血性或出血性中风以及非酮症高血糖症是偏身投掷症的主要病因。尽管关于额叶受累的研究有限，但已有强调与颞叶和顶叶梗死相关的偏身投掷症的病例报告发表。病例报告：一名78岁女性因突发左侧偏身投掷症就诊于急诊科。检查时，她意识清醒，对自身和时间定向力正常，能够听从指令。她的神经系统检查以左侧偏身投掷症为显著特征，检查者描述为周期性、不受控制的，涉及左侧上肢和下肢的“投掷”动作，面部未受累。她在急诊科接受了苯二氮䓬类药物治疗，并静脉注射了左乙拉西坦。头颅非增强计算机断层扫描显示左侧基底节区陈旧性腔隙性梗死。随后患者被收入住院部，脑部磁共振成像显示左侧额上回急性点状皮质梗死。门诊脑电图显示右前半球功能障碍。结论：我们描述了一名患有左侧突发偏身投掷症且同侧额上回急性梗死的患者。该病例强调基底节以外的脑损伤可诱发偏身投掷症，尤其是在额叶内，这值得对中央前沟功能及其在调节运动活动中的作用进行进一步研究。
