Treatment of an Uncommon Case of Isolated Hemichorea After Caudate Head Stroke: A Case Report

Case Diagnosis: 77-year-old female with right-sided strokes including the caudate head causing hemichorea

Case Description or Program Description: Patient presented with acute left hemiparesis, gait instability, and hemichorea, characterized by brief irregular contractions of her left extremities. Although she could ambulate household distances with a front-wheeled walker and minimum assistance, her severe left-sided hemichoreiform movements significantly interfered with her ability to sleep and perform activities of daily living (ADLs). She also displayed impaired coordination in the left extremities and poor activity tolerance.

Setting: Inpatient Rehabilitation Facility (IRF)

Assessment/Results: Her IRF course focused on decreasing ADL limitations posed by hemichorea. Risperidone was started in conjunction with physical and occupational therapies utilizing weights to focus on fine and gross motor coordination. Significant improvement in hemichorea and coordination was seen prior to discharge home and risperidone was no longer needed.

Discussion (relevance): 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. In severe cases or in those in which the movements may interfere with ADLs, patients may require pharmacological treatment with antidopaminergic therapy (typical and atypical neuroleptics) or catecholamine-depleting agents. Atypical neuroleptic agents, such as risperidone, provide better tolerability than first generation antipsychotics. Cases refractory to medication management may be considered for surgical intervention with chronic thalamic stimulation or thalamotomy. In our poster we will expand upon risks and benefits of different treatment options.

Conclusions: Isolated hemichorea is an uncommon post-stroke movement disorder that often displays spontaneous remission. In severe cases, patients may benefit from pharmacological treatment using atypical neuroleptic agents.