[Case report: hemiballism due to a putaminal cavernous hemangioma].
A rare case of reversible hemiballism due to putaminal pathological process in a 51-year-old woman is described. She was hospitalized for evaluation of hemiballism and muscle weakness on the left side. A cranial computed tomography scan demonstrated a high density lesion in the right putamen with enhancement on delayed scan. Angiographic examination revealed no apparent abnormalities. Magnetic resonance imaging with T1 weighted showed a isodense lesion in the right putamen, while T2 weighted image revealed a ring like low signal area around a high signal lesion. These findings were compatible with the diagnosis of cavernous hemangioma. In order to establish the final diagnosis, CT-guided stereotaxic biopsy was carried out. But histological specimen showed only gliosis and calcification. Immediately after the biopsy, a small hemorrhage took place in the right putamen extending to the head of caudate nucleus head. Following this episode, hemiballism ceased, however, it gradually returned along with absorption of hemorrhage. The speculated pathophysiology of this on-and-off hemiballism was as follows; it initially developed as the result of suppression of inhibitory fibers from the striatum to the pallidum by a minor hemorrhage of putaminal cavernous hemangioma, and ceased by declining the activities of the pallidum due to interruption of excitatory fibers from the thalamus and the cortex to the striatum.
Hidaka
M
M
Department of Neurosurgery, Tokai University, Kanagawa, Japan.
Shimoda
M
M
Sato
O
O
Watabe
T
T
Tsugane
R
R
Ohsuga
H
H
Araki
G
G
D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006392:Hemangioma, Cavernous / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D011699:Putamen; D012008:Recurrence; D014057:Tomography, X-Ray Computed