title: Involuntary movement induced by cerebral ischemia: pathogenesis and surgical outcome.
abstract: OBJECTIVE
  Involuntary movement is an uncommon manifestation of a transient ischemic attack. It may be induced by cerebral hemodynamic insufficiency, which is associated with several cerebral ischemic diseases. The authors present three cases of limb shaking due to moyamoya disease (MMD) or radiation-induced middle cerebral artery stenosis, and three additional cases of choreic movement due to MMD. Neuroimaging studies and surgical outcomes in these patients were retrospectively analyzed to investigate the pathological mechanism underlying the symptoms and to provide guidance for the management of involuntary movement disorders in cases of ischemic cerebral disease.
  
  
  METHODS
  The patient population included two children and four adults with ages at presentation ranging between 7 and 50 years. The initial presenting symptoms were involuntary movements in all six cases. A magnetic resonance imaging finding common in all cases was a small infarct in the frontal corona radiata, which did not extend to the cortex or basal ganglia. A perfusion defect in the frontoparietal cortical and subcortical regions was demonstrated by single-photon emission computerized tomography in all patients. Improved hemodynamic circulation in the frontoparietal cortical and subcortical regions occurred in parallel with clinical improvement following indirect or direct bypass surgery.
  
  
  CONCLUSIONS
  Ischemic dysfunction of the frontal cortical and subcortical motor pathways rather than that of the basal ganglia was suspected to be the cause of the observed contralateral involuntary movements. Direct and indirect bypass surgery can be used effectively to treat involuntary movements in patients with cerebral ischemic diseases such as MMD and in those with stenosis of an intracranial major artery.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: So-Hyang
authors.initials: SH
authors.lastname: Im
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Byung-Kyu
authors.initials: BK
authors.lastname: Cho
authors.forename: Young-Seob
authors.initials: YS
authors.lastname: Chung
authors.forename: Dae Hee
authors.initials: DH
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D002533:Cerebral Angiography; D002648:Child; D020820:Dyskinesias / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007089:Image Enhancement; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology / Q000601:surgery; D009072:Moyamoya Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D009434:Neural Pathways / Q000503:physiopathology / Q000601:surgery; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D015899:Tomography, Emission-Computed, Single-Photon