1322 - Treatment of an uncommon case of isolated hemichorea after caudate head stroke; a case report

Case Diagnosis: Isolated hemichorea from caudate head stroke

Case Description: A 77-year-old female presented with acute left hemiparesis, gait instability, and hemichorea, characterized by brief irregular contractions of her left extremities. During her inpatient rehabilitation facility (IRF) stay, the patient demonstrated impaired coordination and poor activity tolerance. Her severe left-sided hemi-choreiform movements significantly interfered with her sleep and posed limitations in performing activities of daily living (ADLs). To address these limitations, risperidone was initiated and rehabilitation therapy utilized weights to focus on gross motor coordination. The patient demonstrated significant improvement in hemi-choreiform symptoms during her IRF stay at which point, risperidone was stopped prior to discharge.

Discussions: Hemichorea is an uncommon stroke symptom and reported by Chung SJ, et al. to be seen in only 0.54% of patients after stroke. Hemichorea typically has a benign course with spontaneous remission or substantial symptom improvement occurring in the majority of patients. A study by Bansil showed 56% of post stroke chorea resolve within 40 days, while the remainder can last up to 41 months. Rehabilitation treatment should utilize weighted therapies. Pharmacologic interventions include antidopaminergic (typical and atypical neuroleptics) or catecholamine-depleting agents. Specifically, atypical neuroleptic agents such as risperidone have demonstrated better tolerance when compared to first generation antipsychotics. Furthermore, cases refractory to conservative management may be considered for surgical intervention with chronic thalamic stimulation or thalamotomy.

Conclusions: Isolated hemichorea is an uncommon post-stroke movement disorder that often displays spontaneous remission. In cases with severe persisting symptoms, patients may benefit from comprehensive care utilizing atypical neuroleptic, pharmacologic agents alongside specialized rehabilitation therapy.