Case Report: Ischaemic Stroke Presented with Hemichorea-Hemiballism


  • Bonfilio Neltio Ariobimo RSUD Ibnu Sina Kabupaten Gresik
  • Vania Ayu Puspamaniar
  • Nujum
  • Lisa Puspitorini



hemichorea, hemiballism, ischaemic stroke


Introduction: Movement disorders can be separated into hypokinetic disorders, which cause paucity or slowness (bradykinesia), and hyperkinetic disorders, which cause excessive, aberrant involuntary motions Less than 5% of individuals with cerebrovascular diseases presented with involuntary movement. It might be difficult to identify and diagnose hyperkinetic disorders.

Case: We describe a 56-year-old man who arrived at the hospital with 5 hours of abrupt, uncontrollable movement in his right upper and lower limbs. A complete neurological evaluation revealed an uncontrolled, nonrhythmic, non-patterned, aimless, and frequently jerky movement of the right upper and lower limbs with a ballistic component that varies in amplitude and frequency. Higher psychic function and cranial nerves were normal. Chest radiography, electrocardiography were normal. Hemorrhage was ruled out by a brain non-contrast CT scan at admission. The patient was diagnosed with hemichorea-hemiballism caused by an ischemic stroke based on clinical evidence of a sudden neurological deficit of aberrant involuntary movement. After receiving medical treatment for five days, the involuntary motions stopped occurring without causing any more neurological abnormalities or weakening.

Discussion: Ischemic stroke diagnosis relied on skilled clinical assessment without explicit neuroimaging. While hemiballismus is characterized by violent irregular flinging movements of the limbs brought on by contractions of the proximal muscles, hemichorea consists of continuous random, anarchic, and jerking movements involving both the distal and proximal muscles (though it is occasionally localized more distally).

Conclusion : Hyperkinetic movement disorders are a rare presentation of stroke. The pathophysiology of these abnormal movements remains uncertain. Even though they are uncommon, following a stroke, aberrant motions can occur suddenly or develop gradually. Hemichorea-hemiballismus with abrupt onset should be treated as an acute stroke unless proven other causes


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Alonso, J. V., Del Pozo, F. J. F., Simón, J. C., Valenzuela, S., Perez Gomez, F., & Lopera, E. (2015). Limb-Shaking TIA Presenting as Hemichorea-Hemiballismus: TIA Chameleons Diagnostic Challenge in the Emergency Department. Journal of Stroke and Cerebrovascular Diseases, 24(11), e327–e331.

Bembenek, J. P., Bilik, M., & Członkowska, A. (2015). Successful treatment with intravenous recombinant tissue plasminogen activator in an acute stroke patient presenting with hemiballism. Functional Neurology, 30(1), 71–72.

Caproni, S., & Colosimo, C. (2017). Movement disorders and cerebrovascular diseases: from pathophysiology to treatment. Expert Review of Neurotherapeutics, 17(5), 509–519.

Carbayo, Á., Sarto, J., Santana, D., Compta, Y., & Urra, X. (2020). Hemichorea as Presentation of Acute Cortical Ischemic Stroke. Case Series and Review of the Literature. Journal of Stroke and Cerebrovascular Diseases, 29(10), 1–4.

Carrion, D. M., & Carrion, A. F. (2013). Non-ketotic hyperglycaemia hemichorea-hemiballismus and acute ischaemic stroke. BMJ Case Reports, 1–3.

Chen, H., & Xu, Z. (2020). Hemichorea-hemiballismus as the initial manifestation of symptomatic middle cerebral artery dissection: A case report. Medicine, 99(36), e22116.

Cincotta, M., & Walker, R. H. (2022). One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea. Tremor and Other Hyperkinetic Movements, 12(1), 1–14.

Defebvre, L., & Krystkowiak, P. (2016). Movement disorders and stroke. Revue Neurologique, 172(8–9), 483–487.

Guida, D., Biraschi, F., Francione, G., Orzi, F., & Fantozzi, L. M. (2013). Hemichorea-hemiballism syndrome following a thrombo-embolic striatal infarction. Neurological Sciences, 34(4), 599–601.

Hao, M., Qin, X., & Gao, H. (2015). A case of Hemichorea-Hemiballism Induced by Acute Infarction of Bilateral Corona Radiata and Cortex. Cell Biochemistry and Biophysics, 73(1), 171–174.

Laganiere, S., Boes, A. D., & Fox, M. D. (2016). Network localization of hemichorea-hemiballismus. Neurology, 86(23), 2187–2195.

Paliwal, P., Dash, D., & Krishnamurthy, S. (2018). Pharmacokinetic Study of Piracetam in Focal Cerebral Ischemic Rats. European Journal of Drug Metabolism and Pharmacokinetics, 43(2), 205–213.

Siniscalchi, A., Gallelli, L., Labate, A., Malferrari, G., Palleria, C., & De Sarro, G. (2012). Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management. Current Neuropharmacology, 10(3), 254–262.

Tater, P., & Sanjay, P. (2021). Post-stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management. Neurology India, 69(2), 272–283.

Tortiglione, A., Minale, M., Pignataro, G., Amoroso, S., DiRenzo, G., & Annunziato, L. (2002). The 2-oxopyrrolidinacetamide piracetam reduces infarct brain volume induced by permanent middle cerebral artery occlusion in male rats. Neuropharmacology, 43(3), 427–433.

Ueta, Y., Kato, H., Naito, M., Taguchi, T., Terashi, H., & Aizawa, H. (2021). Persistent hemichorea as a preceding symptom of cerebral infarction due to middle cerebral artery stenosis. Internal Medicine, 60(23), 3805–3808.

Wei, J., & Zhang, Y. (2021). Hemichorea in a patient with ipsilateral cortical infarction: a case report. BMC Neurology, 21(1), 1–5.

Wheble, P. C. R., Sena, E. S., & Macleod, M. R. (2008). A systematic review and meta-analysis of the efficacy of piracetam and piracetam-like compounds in experimental stroke. Cerebrovascular Diseases, 25(1–2), 5–11.




How to Cite

Ariobimo, B. N., Puspamaniar, V. A., Nujum, N., & Puspitorini, L. (2023). Case Report: Ischaemic Stroke Presented with Hemichorea-Hemiballism. International Islamic Medical Journal, 5(1), 24–35.