Dados do Trabalho

Título

Hyperkinetic movements of hyperacute onset: A case report treated with rTPA

RESUMO

Case presentation: 64-year-old woman, hypertensive, previously functional (Rankin 0). She had sudden dysarthria, central facial palsy (CFP), and left hemiparesis. There was the resolution of the deficits and a clinic picture of hyperkinetic movements began. She was admitted to the neurological emergency with a stroke in the therapeutic window for thrombolytic treatment and on physical examination, chorea movements were observed, characterized by brief, random and irregular involuntary muscle contractions affecting the left side, associated with a slight effacement of the ipsilateral nasolabial fold and slurred speech. NIHSS: 2 (dysarthria and CFP). Cranial computed tomography: 10 aspects and cranial computed tomography angiography: occlusion in the proximal segment of the right middle cerebral artery. No dysglycemia. After ruling out exclusion criteria, thrombolysis was performed. A few minutes after the rTPA, she had a resolution of the movement disorder. Control image delimited lesion in Lentiform Nucleus and Insula section on the right. The investigation of the mechanism evidenced Atrial Fibrillation as, a probable cardioembolic mechanism. The deficits were discharged stable and with outpatient follow-up. Discussion: Movement changes can be primary (genetic) or secondary to cerebrovascular disease, autoimmune conditions, metabolic causes, neoplasms (mass effect or paraneoplastic syndromes), iatrogenic (drug-induced), or trauma. Movement disorders secondary to stroke are a rare manifestation of cerebrovascular disease. They account for up to 22% of secondary movement disorders and develop in 1-4% of stroke patients. The main structures affected are the basal ganglia (44%) and thalamus (37%), although there are case studies that also affect the cerebral cortex. Vascular chorea is rarely progressive and may regress spontaneously in about half of patients, but others may persist with symptoms and need to be treated. Final remarks: Although rare, the initial presentation of acute cerebral ischemia may present with hyperkinetic movement disorders and should be an important differential diagnosis for acute-onset chorea. Thus, rapid and decisive action must be performed with an acute phase protocol.

Palavras Chave

Stroke; hyperkinetic movements; rTPA