Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Chorea due to chronic subdural hematoma

Tomotaka Shiraishi, M.D.1), Renpei Sengoku, M.D., Ph.D.1), Shigehiko Takanashi, M.D.2), Mari Shibukawa, M.D.1), Kazutomi Kanemaru, M.D., Ph.D.1) and Shigeo Murayama, M.D., Ph.D.1)

1)Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology
2)Department of Neurosurgery, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology

An 86-year-old woman presented with generalized chorea in the face and extremities, which gradually progressed for two weeks. Cranial CT revealed a chronic subdural hematoma (CSDH) that covered the left parietal lobe. Discontinuation of amantadine did not improve the chorea. The hematoma was evacuated and the chorea completely subsided in a week. The pathogenesis leading to chorea in CSDH remains unclear. A unilateral hematoma presenting with generalized chorea similar to the present patient and two others with unilateral CSDH causing ipsilateral hemichorea have been reported. The rarity of these movement disorders due to CSDH indicates that these patients had a preclinical dysfunction within neuronal networks interconnecting basal ganglia the cerebral cortex. Our findings confirmed that CSDH could cause chorea, and further neuroimaging to evaluate cerebrovascular disease, taking a detailed family history and obtaining information about current medications might reveal factors likely to precipitate the development of chorea.
Supplemental video
Neurological examination at admission showed irregular, asynchronous movements of all her extremities that were not jerky. These movements appeared when the patient was prone and when seated, but disappeared while she was asleep.
Full Text of this Article in Japanese PDF (485K)

(CLINICA NEUROL, 58: 399|402, 2018)
key words: chorea, chronic subdural hematoma, amantadine, Huntington's disease

(Received: 25-Sep-17)