Abstract Details

Title The Natural History of Hemiballism

Topic Movement Disorders

Presentation(s) P07 - (-)

Poster/Presentation
Number 215

Objective

Background BACKGROUND: Hemiballism is a movement disorder that was classically believed to carry a grave prognosis. However, recent literature generally highlights its self-limiting course and a good prognosis. We recently experienced a patient with hemiballism following stroke who had a fatal outcome. This case series study reviewed clinical features of hemiballism patients and tried to identify prognostic factors.

Design/Methods DESIGN/METHODS: From the in-patient database of our department for these 18 years, patients presenting with hemiballism were extracted, and their clinical features were reviewed.

Results RESULTS: Seven cases (2 men and 5 women) were extracted. Their age was 76.0±10.2 (62-89) years. Involuntary movements of all patients were violent and had a rotating element, and were diagnosed as hemiballism. The onset was acute in 6 patients and subacute in the other patient. Acute cerebral infarction that could explain the symptom was found in two cases, in the subthalamic nucleus and putamen, respectively. However, no causative factors including hyperglycemia were identified in the other 5 cases. Medication such as haloperidol was given for all cases. For 6 cases, the hemiballism disappeared spontaneously within 7-50 days, and no permanent treatment was necessary. However, in a case with an acute infarction of ca 1 cm diameter affecting exactly the subthalamic nucleus, the movement was refractory to any medical treatments. Continuous general anesthesia was required and its interruption always provoked the recurrence of the hemiballism. She was complicated by severe pneumonia and multiple organ failure and died 5 months after the onset.

Conclusions CONCLUSIONS: A majority of patients presenting with hemiballism without a demonstrable lesion in the subthalamic nucleus generally carry a good prognosis. However, hemiballism caused by a destructive lesion localized in the subthalamic nucleus may be refractory and have a poor prognosis, just like the classical description.

Authors/Disclosures
PRESENTER	No disclosure on file
Masahiro Sonoo	No disclosure on file
	No disclosure on file
Yuki Hatanaka, MD (Teikyo University Hospital)	No disclosure on file
Johannes Dworzak	No disclosure on file

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