Hemiballismus

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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79 Hemiballismus

Instruction

Look at this patient.

Salient features

History

• Sudden onset

• Cardiovascular disease for source of emboli: atrial fibrillation, valvular heart disease or severe left ventricular dysfunction.

Examination

• Unilateral, involuntary, flinging movements of the proximal upper limbs.

Diagnosis

This patient has hemiballismus (lesion) caused by a stroke (aetiology), and has severe exhaustion (functional status).

Advanced-level questions

Where is the lesion?

It is often thought that hemiballismus is caused most commonly by a lesion in the contralateral subthalamic nucleus, but the localization is usually elsewhere. It may result from lesions affecting the afferent or efferent pathways of the subthalamic nucleus, corpus striatum, thalamus, parietotemporal or frontal cerebral cortex.

What is the underlying cause?

• Vascular event, usually an infarct

• Rarely tumour, abscess, multiple sclerosis, arteriovenous malformation, cerebral trauma.

What investigations would you do?

• ECG for atrial fibrillation

• Echocardiogram to rule out source of emboli

• CT scan, but this is usually unhelpful because the lesion is small

• MRI of brain may be useful.

What is the prognosis?

The prognosis for recovery is usually good and most patients recover within 1 month. Hemiballismus may occasionally prevent the patient from eating and can be exhausting or even life threatening.

Which drug is usually used in ameliorating this condition?

Tetrabenazine haloperidol, or levetiracetam are useful. Prolonged and medically intractable hemiballism can be treated with contralateral thalamotomy or pallidectomy.

JB Luys (1828–1897), a French neurologist who also studied insanity, hysteria and hypnotism.

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79 Hemiballismus

Instruction

Look at this patient.

Salient features

History

• Sudden onset

• Cardiovascular disease for source of emboli: atrial fibrillation, valvular heart disease or severe left ventricular dysfunction.

Examination

• Unilateral, involuntary, flinging movements of the proximal upper limbs.

Diagnosis

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