21/28. Olanzapine for the treatment of hemiballismus: A case report.Hemiballismus is a rare movement disorder characterized by involuntary, large amplitude movements of the limbs of 1 side of the body. We describe the case of a man in his late sixties with slurred speech, agitation, and right-sided hemiballismus resulting from a left thalamic hemorrhagic stroke. Treatment with haloperidol was unsuccessful, but both the hemiballismus and agitation diminished significantly after initiation of olanzapine (Zyprexa). The improvement in the hemiballismus was quantified by recording the number of hemiballistic movements that occurred while the patient performed standardized 30-minute sessions (daily for 5d). With the first task (reaching within the base of support while seated), the average number of hemiballismic movements per session decreased from a baseline of 23.5 to 3.0 in the upper extremity and from 20.5 to 7.0 in the lower extremity. With the second task (catching a ball while seated), the abnormal movements decreased from 52 to 6.3 in the upper extremity and from 34.5 to 2.7 in the lower extremity. This case suggests that olanzapine may be a valuable pharmacologic alternative for patients with hemiballismus.- - - - - - - - - - ranking = 1keywords = limb, upper, extremity (Clic here for more details about this article) |
22/28. Ballism after stroke responds to standard physical therapeutic interventions.OBJECTIVE: To report the effects of noninvasive standard physical therapy (PT) interventions on an involuntary movement disorder after stroke. DESIGN: Single case with clinical follow-up over 2 years. SETTING: Inpatient stroke and rehabilitation services and outpatient clinic. PARTICIPANT: A man with acute bilateral ballism after unilateral subthalamic infarction. INTERVENTIONS: Rhythmic coordinated bilateral limb movements and firm tactile stimulation to the hand. MAIN OUTCOME MEASURES: We had not anticipated that dyskinesia itself would specifically improve during treatment. Consequently, we used qualitative clinical observations, including review of videotaped performance, and self-reported limb control. Hypotheses concerning treatment effects were developed after data collection. RESULTS: Involuntary movements recurrently improved within treatment sessions. CONCLUSIONS: PT may improve dyskinesia after stroke. The benefit may be adjunctive or alternative to current invasive treatments of movement disorders after brain injury and merits confirmation. The improvements are consistent with current research indicating that (1) intact cortical, subcortical, cerebellar, and spinal areas interact to generate bilateral rhythmic limb movements that can overcome dyskinesia and (2) tactile stimulation can improve motor deficits associated with basal ganglia disorders. Finally, because functional activities assessments improved our evaluation of ballism, these should be routinely used along with conventional neurologic examination to assess involuntary movement disorders.- - - - - - - - - - ranking = 1.6743394724551keywords = limb (Clic here for more details about this article) |
23/28. Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech.levodopa (L-dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L-dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton-motor subsystems.- - - - - - - - - - ranking = 0.55811315748503keywords = limb (Clic here for more details about this article) |
24/28. Resolution of hemiballism after carotid endarterectomy: case report.A 74-year-old man presented with a 3-week history of involuntary left-sided upper and lower extremity shaking without any focal neurologic deficit. Bilateral carotid artery duplex demonstrated severe stenosis of the right internal carotid artery and moderate stenosis of the left internal carotid artery. A right carotid endarterectomy was performed without complications and resulted in elimination of the left-sided involuntary movements postoperatively.- - - - - - - - - - ranking = 0.14956725307133keywords = upper, extremity (Clic here for more details about this article) |
25/28. Unusual presentation of thyrotoxicosis--a case report and review of literature.BACKGROUND: The majority of patients with thyrotoxicosis are readily diagnosed clinically. It must be accepted however that not every patient presents with the characteristic picture. thyrotoxicosis occasionally presents in an unknown or atypical fashion in which the diagnosis may not be obvious. CASE REPORT: A 45-year-old woman presented with choreoathetoid movements of the right upper limb, persistent vomiting and generalized body weakness. Over the next few weeks, the clinical picture slowly evolved to give the characteristic symptoms and signs of thyrotoxicosis, which were not evident at presentation. thyroid function tests revealed elevated serum thyroxine and triiodothyronine as well as low thyroid stimulating hormone concentrations, confirming the diagnosis of thyrotoxicosis. CONCLUSION: This case illustrates unusual initial presenting features of thyrotoxicosis, which long preceded the development of the characteristic and more common manifestations. This led to a delay in the diagnosis. awareness of these atypical presentations will further assist the physician to make a timely and cost effective diagnosis of this condition.- - - - - - - - - - ranking = 4.5448632122442keywords = upper limb, limb, upper (Clic here for more details about this article) |
26/28. The alien hand syndrome: report of a case and review of the literature.The term "alien hand syndrome (AHS)" comprises many clinical signs of which the common features are the involuntary motor movement of the affected limb and the denial of limb ownership. It can result from several diseases involving corpus callosum or medial frontal cortex. Two major types of AHS were previously classified, callosal and frontal types. Moreover posterior subtype of which the lesions do not involve corpus callosum have been reported. In the present report, the authors describe a 57-year-old man with AHS, aggressive behavior and hemispatial neglect which are the rare manifestations of callosal damage. neuroimaging demonstrated subacute infarction of entire corpus callosum from the rostrum to splenium. A review of the literature on these abnormalities is included in the present paper.- - - - - - - - - - ranking = 1.1162263149701keywords = limb (Clic here for more details about this article) |
27/28. alien hand syndrome in stroke: a report of 2 cases and review of the literature.alien hand syndrome (AHS) is a rare condition that occurs in patients with brain injury. It has also been described in stroke subjects, after callosotomy, and in corticobasal degeneration. The common feature of AHS is the involuntary autonomous activity of the affected extremity that is perceived as being controlled by an external force. AHS as a nosologic entity has been challenged. A complex variety of abnormal involuntary motor behaviors may follow cerebral lesions in different cerebral locations such as the corpus callosum, the parietal, or frontal regions. Although different subtypes of AHS have been distinguished, this classification clearly does not cover the wide clinical variety of abnormal (involuntary) motor behaviors of the upper extremity. In this report, we provide a review of literature on abnormal involuntary motor behaviors of the upper extremity after a stroke, which may help to improve early recognition of AHS and facilitate adjustment of rehabilitation therapy. Furthermore, we briefly discuss the complex variety of abnormal, involuntary motor behaviors that may follow after cerebral lesions, their anatomic substrates, the underlying mechanisms, and the prognosis.- - - - - - - - - - ranking = 0.37051067432881keywords = upper, extremity (Clic here for more details about this article) |
28/28. Successful treatment of posttraumatic hemiballismus with intrathecal baclofen therapy.Intrathecal baclofen (ITB) therapy is widely used in the management of spastic hypertonia and dystonia resulting from a multitude of conditions that present with upper motor neuron syndrome signs, such as cerebral palsy, stroke, brain and spinal injuries, and multiple sclerosis. We report successful management of posttraumatic hemiballismus and dystonia with ITB in a 43-yr-old man who sustained a traumatic brain injury secondary to an assault in 1978. He subsequently developed hemiballismus in the right lower limb and dystonia of the distal right upper limb spreading proximally to involve the shoulder. The ballistic movement of the lower limb was severe enough to cause the patient to fall out of his chair and limit his ability to perform activities of daily living safely. He had been on various oral medications and received botulinum toxin and phenol injections, but none alleviated the symptoms. The patient elected to receive the ITB pump. Before ITB, he had an average of 10-12 ballism episodes of the right lower limb per hour. During observed episodes, the right hip would flex up to about 90 degrees, with a fully extended knee. After ITB pump implantation and upward dose titration, the frequency of ballistic right leg movements decreased to about three per day, and the right hip flexed to only 30 degrees. In addition, there was increased ability to isolate individual distal joint movements in the right lower limb. The patient currently receives 202.4 microg/day ITB and continues to benefit almost 6 yrs after ITB pump implantation. This report highlights the emerging role of ITB in managing movement disorders other than dystonia spastic hypertonia and dystonia.- - - - - - - - - - ranking = 6.8555069270695keywords = upper limb, limb, upper (Clic here for more details about this article) |
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