Look at this patient.
· Sudden onset.· Cardiovascular disease for source of emboli atrial fibrillation, valvular heartdisease or severe left ventricular dysfunction.
Unilateral, involuntary, flinging movements of the proximal upper limbs.
This patient has hemiballismus (lesion) due to a stroke (aetiology), and has severe exhaustion (functional status).
Where is the lesion?
In the ipsilateral subthalamic nucleus of Luys.
What is the underlying cause?
· Vascular event, usually an infarct.· Rarely tumour, abscess, multiple sclerosis, arteriovenous malformation, cerebral trauma.
What investigations would you perform?
· ECG for atrial fibrillation.· Echocardiogram to rule out source of emboli.· CT scan, but this is usually unhelpful because the lesion is small.
What is the prognosis?
The prognosis for recovery is usually good and most patients recover within 1 month. Hemiballismus may occasionally prevent thepatient from eating and can be exhausting or even life threatening.
Which drug is usually used to ameliorate this condition?
Tetrabenazine or haloperidol is usually effective. Prolonged and medically intrac-table hemiballismus can be treated withcontralateral thalamotomy or pallidectomy.J.B. Luys (1828-1897), a French neurologist who also studied insanity, hysteria and hypnotism.