title: Development of involuntary movements after ventriculoperitoneal shunting for normal pressure hydrocephalus in a patient with chronic-phase thalamic haemorrhage.
abstract: BACKGROUND
  Delayed-onset involuntary movements have been described after thalamic stroke.
  
  
  METHODS
  We treated a patient with involuntary movements that increased after ventriculoperitoneal shunting (VPS) for normal pressure hydrocephalus (NPH) following thalamic haemorrage. One and one-half years after right thalamic and intraventricular haemorrhage, NPH suggested clinical evaluation and neuroimaging studies in a 56-year-old man.
  
  
  RESULTS
  Hemidystonia and pseudochoreoathetosis were evident in the left arm, leg and trunk. Proprioceptive impairment and mild cerebellar dysfunction affected the left upper and lower extremity. Yet the patient could walk unassisted and carry out activities of daily living (ADL) rated as 90 points according to the Barthel Index (BI). Lumbar puncture lessened both gait disturbance and cognitive impairment. After VPS, cognition and urinary continence improved, but involuntary movements worsened, precluding unaided ambulation and decreasing the BI score to 65 points. Computed tomography after VPS showed resolution of NPH, while single-photon emission computed tomography showed increased cerebral blood flow after VPS.
  
  
  CONCLUSIONS
  Increased cerebral blood flow after VPS is suspected to have promoted development of abnormal neuronal circuitry.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan. krugreims@yahoo.co.jp
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Shindo
authors.forename: Takeo
authors.initials: T
authors.lastname: Kondo
authors.forename: Ken
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nishijima
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Furusawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mori
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Izumi
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis; D002560:Cerebrovascular Circulation; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D013786:Thalamic Diseases / Q000150:complications* / Q000175:diagnosis; D015899:Tomography, Emission-Computed, Single-Photon; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*