Paroxysmal dyskinesia as an unusual and only presentation of subcortical white matter ischaemia: a report of two cases.
Secondary paroxysmal dyskinesias (PxD) have been previously reported in patients with multiple sclerosis, lacunar infarcts, head trauma, metabolic disorders such as hyperglycaemia, hypocalcaemia, migraine and central nervous system (CNS) infections. The causative lesions typically involve the basal ganglia structures, medulla and rarely the spinal cord. We report two patients who presented with paroxysmal dyskinesias as the only manifestation of subcortical white-matter ischaemia. Patient 1 presented with 3-year history of paroxysmal kinesigenic dyskinesia (PKD) and patient 2 with 6-month history of paroxysmal nonkinesigenic dyskinesia (PNKD). All investigations, including CSF oligoclonal bands were negative, except for a brain MRI which showed multiple, non-enhancing subcortical white matter lacunar infarcts. Therefore, subcortical white matter ischaemia should also be included in the differential diagnosis of PxD.
Neurology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia. norlinah@mail.hukm.ukm.my
M I
MI
Norlinah
A M M
AM
Shahizon
D000328:Adult; D001241:Aspirin / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D020520:Brain Infarction / Q000150:complications* / Q000175:diagnosis*; D002220:Carbamazepine / Q000627:therapeutic use; D002819:Chorea / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D002220:Carbamazepine; D001241:Aspirin