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Hemichorea due to hemodynamic ischemia associated with extracranial carotid artery stenosis

Report of two cases

Ryoma Morigaki Department of Neurosurgery, Faculty of Medicine, The University of Tokushima, Japan

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 M.D.
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Masaaki Uno Department of Neurosurgery, Faculty of Medicine, The University of Tokushima, Japan

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Atsuhiko Suzue Department of Neurosurgery, Faculty of Medicine, The University of Tokushima, Japan

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Shinji Nagahiro Department of Neurosurgery, Faculty of Medicine, The University of Tokushima, Japan

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Page Range:
142–147
Volume/Issue:
Volume 105: Issue 1
DOI link:
https://doi.org/10.3171/jns.2006.105.1.142
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✓ In this paper the authors describe two patients with recurrent hemiparesis and limb shaking that gradually progressed to hemichorea. Cerebral angiography confirmed severe unilateral internal carotid artery stenosis (95%) contra-lateral to the hemichorea. The cerebral blood flow, assessed using N-isopropyl-p-(iodine-123) iodoamphetamine single-photon emission computed tomography (SPECT), disclosed markedly decreased vascular reserves in both patients. After carotid endarterectomy was performed, the hemichorea gradually subsided and SPECT confirmed increased cerebral perfusion. The results in these cases indicate that surgical revascularization is effective for hemichorea due to cerebral ischemia with reduced vascular reserve.

Abbreviations used in this paper:

CBF = cerebral blood flow; CEA = carotid endarterectomy; ECA = external carotid artery; HCHB = hemichorea–hemiballism; ICA = internal carotid artery; 123I-IMP = N-isopropyl-p-(iodine-123) iodoamphetamine; MR = magnetic resonance; SPECT = single-photon emission computed tomography.
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Volume 105: Issue 1

Contributor Notes

Address reprint requests to: Masaaki Uno, M.D., Department of Neurosurgery, Faculty of Medicine, The University of Tokushima, 3-18-15 Kuramotocho, Tokushima, Japan 770-8503. email: muno@clin.med.tokushima-u.ac.jp.
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