Afternoon Tea Hemichorea

A 78-year-old woman, with a medical history of hypertension, presented to the Accident & Emergency Department after a sudden onset of right-sided involuntary movements while she was having afternoon tea with her friends. Examination showed isolated unilateral chorea, affecting the right arm and leg (Video 1). Her blood glucose and sodium levels were normal. The MRI head scan showed a left globus pallidus infarct (Figure). Tetrabenazine was prescribed with very good response and weaned off after 4 weeks. Hyperkinetic movement disorders are uncommon in acute stroke (1%).¹ Lesions in regions functionally connected to the posterolateral putamen are implicated in hyperkinetic movement disorders.² The differential diagnosis includes hyperglycemia, hyponatremia, and drug-induced chorea. In cases of sudden onset, it is important to recognize stroke as a possible cause to avoid missing reperfusion therapy opportunities.

Figure. MRI Head Scan.

(A) Axial diffusion-weighted imaging. (B) Axial fluid-attenuated inversion recovery imaging. Infarct on the left globus pallidus.

Video 1

Download Supplementary Video 1 ^{(15.8MB, mp4)} via http://dx.doi.org/10.1212/001048_Video_1

Appendix. Authors

Study Funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.