76y/o man with history of hypertension and dyslipidemia presented to hospital with a one-week history of involuntary movements on the left side of the body. No improvements were observed after Lorazepam was administered. Patient was transferred to our hospital for neurological evaluation. At arrival, vital signs were within normal limits. Neurological exam was remarkable for involuntary, irregular, non-stereotypical movements of the left arm and leg. The patient could suppress these movements for short periods of time. Non focal deficits were appreciated. Hematological and basic metabolic panel results were non-revealing. MRI brain showed punctate areas of restricted diffusion in the right parietal lobe, but the basal ganglia were normal. CTA was remarkable for a 90-99% stenosis of the right internal carotid artery.

Patient underwent uncomplicated CEA three days later, with complete resolution of symptoms 48 hours post-surgery. No reoccurring symptoms have been reported.

N/A

N/A

Chorea is a hyperkinetic movement disorder characterized by random, flowing, low-amplitude, involuntary movements predominantly affecting the distal portions of upper and lower limbs. Chorea can be caused by metabolic, ischemic, and neurodegenerative conditions. Hemichorea is the most common movement disorder post-stroke and has been associated primarily with ischemic lesions in the contralateral basal ganglia, often, involving the subthalamic nucleus. Limb shaking syndrome is an uncommon type of transient ischemic attack described by Miller Fisher after his observations of patients with severe carotid stenosis. Hemichorea is a rarer physical exam finding, resulting in more dramatic movements, often confused with partial epilepsy.  Both conditions, are associated with a low perfusion state in the subcortical watershed areas and usually resolve shortly after carotid endarterectomy.

-Movement disorders are uncommon presentation of cerebrovascular diseases and often mistaken for epilepsy.

1. -Recognizing hemichorea as a potential manifestation of cerebral hypoperfusion is critical to prevent permanent ischemic injuries.