Hyperkinetic movement disorders in the onset of stroke

Hyperkinetic movements (HM) as the sole or leading syndrome in the onset of stroke is observed in less than 1% of stroke cases and can lead to diagnostic difficulties, disrupting routing and delaying the administration of reperfusion therapy.

Four observations are presented: two with acute development of hemichorea/hemiballismus and one each with recurrent transient episodes of myoclonus and spastic torticollis. According to neuroimaging data, in patients with hemichorea/hemiballismus, the foci were located in the anterior parts of the corona radiata in the projection of the descending pathways from the cortex to the striatum and in the putamen. In a patient with spastic torticollis, the focus was in the thalamus. In a patient with recurrent myoclonic hyperkinesis, no changes in perfusion (CBV and Tmax) were found during hyperkinesis, but computed tomography revealed post-stroke cysts in the right somatosensory area and in the right hemisphere of the cerebellum.

The occurrence of HM may be caused not only by structural changes, but also by functional disorders of the neural networks involved in the integration of motor activity.

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