A Case Of Hemiballism Resembling Unilateral Body Seizures After Ischemic Stroke

Abstract

Hemibalism is a rare neurological condition characterised by sudden, uncontrollable, large-amplitude movements, usually on one side of the body, which involve arms and legs. Hemiballismus is related to the damage of hypothalamic nucleus resulting in uncontrolled muscle motor activity.Aim of the study.Materials and methodsAn 84-yearold woman developed involuntary movements of the right arm after a previous ischemic stroke, focal seizure was suspected. Recurrent involuntary movements of the right arm with no loss of consciousness and no generalized seizures were observed. Neurological examination revealed sensorimotor aphasia (residual effects of a stroke ( REOS)), adequate amplitude of eye movements in all directions, symmetrical pupils, normal photoreaction, no horizontal nystagmus and a slight flattening of the right nasolabial fold. The patient had persistent plegia of the right arm and paresis of the right leg ( REOS). Patellar reflexes were diminished on the left, a pathological Babinksi reflex was positive on the right side and no meningeal symptoms were observed. Hypokalaemia or hyponatraemia were not observed in the laboratory tests. Brain computed tomography scan showed no acute cerebrovascular pathology. After recurrent twitching of the right arm, the right leg also began to twitch. Suspecting seizures, carbamazepine was prescribed, but no effect was observed. An encephalogram was not performed due to technical difficulties. Haemiballism was suspected due to repeated episodes of twitching on one side of the body without loss of consciousness. Carbamazepine was replaced with haloperidol, which led to a reduction in involuntary movements. The patient was discharged home after regression of symptoms.Conclusions. Haemibalism is a condition that occurs as a complication of hypothalamic nucleus damage after an ischaemic stroke. Anamnesis, neurological examination and a CT scan remain the main tests to identify the specific structural lesions and the diagnosis of the disease. Treatment includes dopamine receptor antagonists (haloperidol) and can be helpful in differential diagnosis.