Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Unilateral asterixis after hemiballism in a patient with acute cerebral infarction

Ryoji Nerei, M.D.1)2), Takenobu Murakami, M.D., Ph.D.1), Shinya Kawase, M.D., Ph.D.1), Hiroshi Takigawa, M.D., Ph.D.1) and
Ritsuko Hanajima, M.D., Ph.D.1)

1) Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University
2) Department of Neurology, Tottori Prefectural Kousei Hospital

An-88-year-old right-handed female complained of repeated intermittent hemiballism in the right upper and lower extremities. She presented to our hospital with monoparesis and asterixis of the right arm, but not hemiballism. Brain MRI revealed acute disseminated cerebral infarctions in the middle cerebral artery watershed area of the left hemisphere, including the striatum and cortical areas. Occlusion of the left internal carotid artery was also detected. She was diagnosed as acute cerebral infarction and received intravenous infusion, after which her neurological symptoms gradually improved. We presumed that the intermittent hemiballism was related to dysfunction of the motor loop induced by circulatory insufficiency in the left striatum, and that unilateral asterixis might be induced by hemodynamic hypoperfusion in the left frontal lobe. The hemodynamic changes induced by occlusion of the left internal carotid artery might be associated with pathogenesis of these involuntary movements.
Supplemental video 1
Hemiballism. The patient showed hemiballism in the right upper and lower extremities. She spoke meaningless words fluently, which is compatible with jargon aphasia. Video 1 is published with patient's permission.
Supplemental video 2
Asterixis of the right arm. When extending both elbows and wrists, she could not maintain the posture of the right arm. The right hand dropped irregularly and rapidly. Video 2 is published with patient's permission.
Full Text of this Article in Japanese PDF (1356K)

(CLINICA NEUROL, 62: 793−796, 2022)
key words: hemiballism, asterixis, occlusion of internal carotid artery

(Received: 16-Feb-22)