Clinical Features of Hyperkinetic Involuntary Movements Controlateral to Hemiplegia in Acute Stroke

The occurrence of abnormal movements is a frequent reason for consultation in neurology. The etiologies are broadly separated into "primary causes", in example intrinsically neurological diseases (of genetic or degenerative origin), and "secondary causes". In addition to certain medications or toxic substances, brain damage can be a cause. In this register, 22% of involuntary abnormal movements are related to a stroke and 1 to 4% of strokes are complicated by abnormal movements.

These are manifested by a parkinsonian syndrome or conversely by hypercinesia which can take the form of chorea or ballisms. Most hyperkinetic movements occur in the acute phase of the neurovascular event. . The pathophysiology seems simple and explained by a direct lesion or hypoperfusion of structures involved in the loops of the basal ganglia, especially when the putamen is affected. Intuitively, these abnormal hyperkinetic movements affect the contralateral hemibody to the vascular lesion, or the ipsilateral rating to the sensory and/ or motor deficit. However, observations have already been reported of involuntary hyperkinetic abnormal movements of the contralateral side to that presenting hemiplegia, i.e. in theorie controlled by a cerebral hemisphere free of acute cerebral lesion.

The frequency of these abnormal movements is still uncertain and their semeiological description has been the subject of only rare publications. A largest cohort reports abnormal involuntary movements very heterogeneous as to their clinical presentation (rotation of the head, orpharyngeal stereotypies to the limbs, compulsive manipulations of the environment or repeated passive mobilization of the contralateral limb paralyzed) In addition, the correlation of this type of neurological manifestations with vascular lesions has not yet been elucidated.

However, the unusual nature of this type of movement, it seems relevant to be interested in the frequency of these neurological phenomena and has their semeiologic characteristic.