Wang XD, Li X, Pan CL. Hemichorea in patients with temporal lobe infarcts: Two case reports. World J Clin Cases 2024; 12(4): 806-813 [PMID: 38322679 DOI: 10.12998/wjcc.v12.i4.806]
Corresponding Author of This Article
Chun-Lian Pan, MM, Chief Physician, Department of Neurology, Puren Hospital Affiliated to Wuhan University of Science and Technology, No. 1 Benxi Road, Wuhan 430081, Hubei Province, China. wxdwhspryy@126.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 6, 2024; 12(4): 806-813 Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.806
Hemichorea in patients with temporal lobe infarcts: Two case reports
Xu-Dong Wang, Xing Li, Chun-Lian Pan
Xu-Dong Wang, Xing Li, Chun-Lian Pan, Department of Neurology, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China
Xu-Dong Wang, School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
Author contributions: Wang XD wrote the manuscript; Li X and Pan CL critically revised the manuscript; and all of the authors have read and approved the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Lian Pan, MM, Chief Physician, Department of Neurology, Puren Hospital Affiliated to Wuhan University of Science and Technology, No. 1 Benxi Road, Wuhan 430081, Hubei Province, China. wxdwhspryy@126.com
Received: October 11, 2023 Peer-review started: October 11, 2023 First decision: November 20, 2023 Revised: December 8, 2023 Accepted: January 8, 2024 Article in press: January 8, 2024 Published online: February 6, 2024 Processing time: 105 Days and 14 Hours
Abstract
BACKGROUND
Hemichorea and other hyperkinetic movement disorders are uncommon presentations of stroke and are usually secondary to deep infarctions affecting the basal ganglia and thalamus. Therefore, temporal ischemic lesions causing hemichorea are rare. We report the cases of two patients with acute ischemic temporal lobe infarct strokes that presented as hemichorea.
CASE SUMMARY
Patient 1: An 82-year-old woman presented with a 1-mo history of involuntary movement of the left extremity, which was consistent with hemichorea. Her diffusion-weighted imaging (DWI) revealed an acute ischemic stroke that predominantly affected the right temporal cortex, and magnetic resonance angiography of the head showed significant stenosis of the right middle cerebral artery (MCA). Treatment with 2.5 mg of olanzapine per day was initiated. When she was discharged from the hospital, her symptoms appeared to have improved compared with those previously observed. Twenty-seven days after the first admission, she was readmitted due to acute ischemic stroke. Computed tomography perfusion showed marked hypoperfusion in the right MCA territory. An emergency transfemoral cerebral angiogram was performed and showed severe stenosis in the M1 segment of the right MCA. After percutaneous transluminal angioplasty was successfully performed, abnormal movements or other neurologic problems did not occur. Patient 2: A 76-year-old man was admitted to our hospital for a 7-d history of right-upper-sided involuntary movements. DWI showed an acute patchy ischemic stroke in the left temporal lobe without basal ganglia involvement. Subsequent diffusion tensor imaging confirmed fewer white matter fiber tracts on the left side than on the opposite side. Treatment with 2.5 mg of olanzapine per day improved his condition, and he was discharged.
CONCLUSION
When acute hemichorea suddenly appears, temporal cortical ischemic stroke should be considered a possible diagnosis. In addition, hemichorea may be a sign of impending cerebral infarction with MCA stenosis.
Core Tip: Temporal ischemic lesions causing hemichorea are rare in stroke patients, likely delaying proper diagnosis and treatment. We present two cases in which a temporal lobe infarct caused hemichorea. Considering the well-established and time-dependent benefits of reperfusion therapies, we believe that acute onset of hemichorea likely leads to acute stroke. It should be noted that middle cerebral artery stenosis can present with persistent hemichorea, even in the absence of cerebral infarction. Thus, vascular imaging is essential for patients presenting with hemichorea.
