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Advanced Neurology

CASE REPORT
Choreoathetosis of the upper limb with

contralateral substantia nigra lacunar
infarction: A case report and literature review

Mengxin Li, Xiaojun Zhang, and Yanqiang Wang*

Department of Neurology Ⅱ, The Affiliated Hospital of Weifang Medical University, Weifang,
Shandong, China

Abstract

Choreoathetosis of the upper limb as the first manifestation of contralateral substantia
nigra (SN) lacunar infarction is extremely rare. We report a case of choreoathetosis
of the right upper limb in a 60-year-old man with SN infarction. Emergency brain
magnetic resonance imaging showed discrete lacunar infarction localized in the left
SN. Magnetic resonance angiography showed atherosclerotic stenosis of the basilar
artery and the left posterior cerebral artery. He was diagnosed with contralateral SN
infarction and then treated with antiplatelet, loading-dose statins, and allopathic
therapy to achieve a positive outcome. During the follow-up period, there was no
recurrence of stroke, and his symptom of choreoathetosis resolved. More cases alike
should be studied to achieve satisfactory outcomes through early diagnosis and
appropriate treatments.

*Corresponding author:
Yanqiang Wang Keywords: Substantia nigra; Dance-like movements; Ischemic stroke
(wffywyq2006@126.com)
Citation: Li M, Zhang X, Wang Y,
2023, Choreoathetosis of the upper
limb with contralateral substantia 1. Introduction
nigra lacunar infarction: A case
report and literature review. Adv Substantia nigra (SN), a dopaminergic nucleus located in the midbrain, plays a key role
Neuro, 2(1): 141. in regulating motor movements. The previous studies have indicated that ischemia in
https://doi.org/10.36922/an.v2i1.141
distal brain regions may cause delayed neurodegenerative changes, such as hyperkinetic
Received: June 25, 2022 and hypokinetic syndromes (especially vascular parkinsonism) . However, the
[1]
Accepted: January 9, 2023 previous literature has suggested an inconsistency in the incidence of cerebrovascular
disease-related movement disorders due to the different perception of its scope. According
Published Online: January 27, 2023
to Alarcón et al., the incidence of post-stroke dyskinesia in 2004 was 3.7% . Tater et al.
[2]
Copyright: © 2023 Author(s). have suggested that 1 –4% of all stroke patients may present with movement disorders .
[3]
This is an Open Access article
distributed under the terms of the In particular, there have been several reports of choreoathetosis associated with lacunar
Creative Commons Attribution infarction involving the SN. In this article, we report an unusual case of the right upper
License, permitting distribution, limb choreoathetosis with primary SN infarction and review the relevant literature.
and reproduction in any medium,
provided the original work is
properly cited. 2. Case presentation
Publisher’s Note: AccScience We report an interesting case of acute choreoathetosis as the presenting symptom of acute
Publishing remains neutral with ischemic stroke in a 60-year-old man, which lasted for 5 days. It was characterized by
regard to jurisdictional claims in
published maps and institutional involuntary, irregular, and continuous circular movement of the right upper limb, with
affiliations. the shoulder joint as the axis. The frequency and the duration were uncertain. According

Volume 2 Issue 1 (2023) 1 https://doi.org/10.36922/an.v2i1.141