Cerebral hypoperfusion-related hemichorea: A case report and literature review.

RATIONALE

Hemichorea is an extrapyramidal disorder with diverse etiologies. Vascular hemichorea is most commonly caused by cerebral infarction in the putamen or caudate nucleus, with head diffusion weighted imaging (DWI) showing restricted diffusion at the site of the responsible lesion. Negative DWI in the basal ganglia is extremely rare. This article reports a case of hemichorea caused by a transient ischemic attack in the basal ganglia due to asymptomatic brief cardiac arrest, with negative basal ganglia DWI and dynamic electrocardiogram showing brief cardiac arrest (5.6 seconds).

PATIENT CONCERNS

An 82-year-old previously healthy female presented with "sudden slurred speech and involuntary right-sided body movements lasting 5 hours."

DIAGNOSES

DWI showed restricted diffusion in the left parieto-occipital lobe, but was negative in the basal ganglia. Dynamic electrocardiogram monitoring revealed atrial flutter and brief cardiac arrest (5.6 seconds). After antiplatelet aggregation therapy, the patient's hemichorea completely resolved within 24 hours. Given the negative basal ganglia DWI and after excluding other causes, the diagnosis was a transient ischemic attack in the basal ganglia caused by the 5.6-second cardiac arrest.

INTERVENTIONS

Oral aspirin enteric-coated tablets and atorvastatin calcium tablets were administered, along with intravenous sodium dinitrophenyl chloride injection. The patient was then transferred to the cardiology department for implantation of a dual-chamber permanent pacemaker. Considering the patient's atrial flutter and high bleeding risk, a long-term treatment plan with aspirin enteric-coated tablets and atorvastatin was selected.

OUTCOMES

Symptoms completely resolved. During the 2-year follow-up, there was no recurrence or cerebrovascular disease-related events.

LESSONS

When patients present with acute hemichorea as the primary symptom and have negative DWI in the basal ganglia, a diagnosis of transient ischemic attack in the basal ganglia caused by asymptomatic brief cardiac arrest should be considered. The basal ganglia are particularly sensitive to ischemia, hypoxia, and reperfusion injury, which may be the mechanism by which brief cardiac arrest leads to hemichorea. Timely dynamic electrocardiogram monitoring helps clarify the diagnosis. Early implantation of a permanent pacemaker helps improve prognosis and prevent recurrence.