Uncus Herniation Presenting as Immediate Onset Postoperative Hemichorea

Abstract

Chorea is defined as a state of excessive spontaneous movements, irregularly timed, nonrepetitive, randomly distributed, and abrupt in character. Thalamic and subthalamic lesions are commonly known to cause hemichorea. Here, we describe a patient with hydrocephalus due to aqueductal stenosis that caused hemichorea in the immediate postoperative period due to subthalamic infarct of uncus herniation. Considering that hydrocephalus symmetrically affects the central nervous system, the asymmetric presentation of chorea in the immediate postoperative period after wakening up from anesthesia could be confusing if a possibility of uncus herniation is not considered.

Keywords

hemichorea - subthalamic nucleus - uncus herniation - hydrocephalus

Informed Consent

Informed consent from the patient was taken for the publication of this case report.

• References

• 1 Berman SA. Chorea. In: Joseph AB, Young RR. , eds. Movement Disorders in Neurology and Neuropsychiatry. 2nd ed. Malden, MA: Blackwell Science; 1999: 481-494
• 2 Chung SJ, Im JH, Lee MC, Kim JS. Hemichorea after stroke: clinical-radiological correlation. J Neurol 2004; 251 (06) 725-729
• 3 Takahashi T, Kanamori H, Shigehara R. , et al. Pure hemi-chorea resulting from an acute phase of contralateral thalamic lacunar infarction: a case report. Case Rep Neurol 2012; 4 (03) 194-201
• 4 Chung SJ, Im JH, Lee MC, Kim JS. ; a Hemichorea after stroke: clinical-radiological correlation. J Neurol 2004; 251 (06) 725-729
• 5 Ghika-Schmid F, Ghika J, Regli F, Bogousslavsky J. Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci 1997; 146 (02) 109-116
• 6 Jacob S, Gupta HV. Delayed hemichorea following temporal–occipital lobe infarction. Tremor Other Hyperkinet Mov (N Y) 2016; 6: 414
• 7 Barbeau A, Duvoisin RC, Gerstenbrand F, Lakke JP, Marsden CD, Stern G. Classification of extrapyramidal disorders. Proposal for an international classification and glossary of terms. J Neurol Sci 1981; 51 (02) 311-327
• 8 Holtbernd F, Eidelberg D. Functional brain networks in movement disorders: recent advances. Curr Opin Neurol 2012; 25 (04) 392-401
• 9 Voermans NC, Schutte PJ, Bloem BR. Hydrocephalus induced chorea. J Neurol Neurosurg Psychiatry 2007; 78 (11) 1284-1285
• 10 Germanwala AV, Huang J, Tamargo RJ. Hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 2010; 21 (02) 263-270