Hemiballism-hemichorea from marked hypotension during spinal anesthesia.
Hemiballism and hemichorea following anesthesia-induced hypotension has rarely been described, but a recent case suggests an association. After experiencing marked hypotension during spinal anesthesia, a 70-year-old woman developed hemiballism and hemichorea. Involuntary ballistic movements with writhing, consisting of repetitive rotation and flexion-extension without apparent muscle weakness, affected her left limbs proximally. Low-amplitude, involuntary, choreiform movements involved the distal portions of these limbs. Magnetic resonance imaging demonstrated an area of high signal intensity in the contralateral subthalamic nucleus, suggestive of a focal ischemic lesion. Although such occurrences are rare, anesthesiologists should be aware of the risk of subthalamic nucleus ischemia following marked hypotension.
Itoh
H
H
Department of Anesthesiology and Intensive Care Medicine, Kanazawa University School of Medicine, Japan.
Shibata
K
K
Nitta
E
E
Takamori
M
M
D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D002819:Chorea / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D009069:Movement Disorders / Q000188:drug therapy / Q000209:etiology*; D013787:Thalamic Nuclei / Q000098:blood supply / Q000473:pathology; D001745:Urinary Bladder Diseases / Q000601:surgery
D018726:Anti-Dyskinesia Agents; D006220:Haloperidol