Monochorea in chronic cerebral hypoperfusion with dopaminergic transmission disruption

  • Takao Mitsui
  • Keiji Yoda
  • Masafumi Harada

A total of 1–4% of all patients with stroke develop some type of hyperkinetic or hypokinetic movement disorder, including chorea, ballism, athetosis, dystonia, myoclonus, akathisia, and parkinsonian symptoms [1]. Hemichorea has a similar pathophysiology to that of hemiballism and typically occurs immediately after acute vascular events affecting the subthalamic nucleus (STN). In the classic model of hyperkinesia, a lesion in the STN interferes with the transmission of the indirect pathway, leading to an increased excitatory output to the motor cortex from the thalamus. However, this model has limitations in the extent to which it can explain hemichorea/hemiballism [1]. There is little doubt that some cases are caused by lesions outside the STN, although their pathophysiology remains uncertain [1].

A 63-year-old woman presented with a 4-month history of spontaneous rapid involuntary movements of the right hand. The complex movements involved irregular flexion, extension, and rotation of...


Monochorea Hypoperfusion Internal carotid artery Infarction 


Author contribution

TM supervised all aspects of the study, wrote, and edited the manuscript. KY and MH interpreted the data. All authors involved in the patient treatment participated in manuscript preparation.


The authors report no disclosures relevant to the manuscript. Dr. Mitsui performs clinical and basic research funded by JSPS KAKENHI # 17H00873, #16H05281 and # 16K01492. Dr. Yorita reports no disclosures. Dr. Harada performs neuroimaging study in his clinical practice funded by JSPS KAKENHI #15K09926.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflicts of interest.

Ethical standards

This case study has been approved by the ethics committee/institutional review board (IRB) of Tokushima National Hospital and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from the subject for publication of this case report and accompanying images. A copy of the written consent is available for review upon request.

Informed consent

Written informed consent was obtained from the individual included in the study.

Supplementary material

13760_2018_921_MOESM1_ESM.jpg (82 kb)
Supplementary material 1 Figure S1. A. Cranial magnetic resonance angiography failed to show the left internal carotid artery (ICA). B. Digital subtraction angiography revealed a severe stenosis of the left intracranial ICA with collateral circulation from the left posterior cerebral artery to the left anterior cerebral artery. (JPEG 82 kb)

Supplementary material 2 Video S1 The patient continuously moves the right upper limb in an irregular manner, particularly the hand. (WMV 4239 kb)


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Copyright information

© Belgian Neurological Society 2018

Authors and Affiliations

  1. 1.Department of Neurology, Tokushima National HospitalNational Hospital OrganizationYoshinogawa CityJapan
  2. 2.Department of NeurosurgeryTokushima Prefectural Miyoshi HospitalMiyoshi CityJapan
  3. 3.Department of Radiology, Institute of Health BiosciencesThe University of Tokushima Graduate SchoolTokushimaJapan
  4. 4.Department of Clinical Research, Tokushima National HospitalNational Hospital OrganizationYoshinogawaJapan

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