ABSTRACT
Deep brain stimulation (DBS) of the zona incerta has shown promising results in the reduction of medically refractory movement disorders. However, evidence supporting its efficacy in movement disorders secondary to hemorrhagic stroke or hemichoreoathetosis is limited. We describe a 48-year-old man who developed progressive hemichoreoathetosis with an arrhythmic, proximal tremor in his right arm following a thalamic hemorrhagic stroke. Pharmacological treatment was carried out with no change in the Abnormal Involuntary Movement Scale (AIMS) score after 4 weeks (14). After six sessions of botulinum toxin treatment, a subtle improvement in the AIMS score (13) was registered, but no clinical improvement was noted. The arrhythmic proximal movements were significantly improved after DBS of the zona incerta with a major decrease in the patient’s AIMS score (8). The response to DBS occurring after the failure of pharmacological and botulinum toxin treatments suggests that zona incerta DBS may be an alternative for postthalamic hemorrhage movement disorders.
Subject(s)
Humans , Middle Aged , Abnormal Involuntary Movement Scale , Arm , Botulinum Toxins , Chorea , Deep Brain Stimulation , Hemorrhage , Herpes Zoster , Movement Disorders , Stroke , Tremor , Zona IncertaABSTRACT
We report a case of moyamoya disease in a 7-year-old boy whose initial manifestation was the sudden onset of right hemichoreoathetosis for one week. Magnetic resonance imaging demonstrated a small infarction in the left frontal subcortical white matter. Single photon emission computed tomography (SPECT) revealed a perfusion defect in the same region. Combined superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-arterio-myo-synangiosis (EDAMS) were performed and his symptoms disappeared after surgery. SPECT also normalized after revascularization. Hemichoreoathetosis is a rare initial manifestation of moyamoya disaese and direct and indirect anastomosis is effective treatment of this rare symptom.