title: A Case of Complete Resolution of Hemiballismus After Carotid Endarterectomy.
abstract: BACKGROUND
  Hemiballismus is a rare presentation of symptomatic carotid stenosis that is underreported in the neurosurgical literature. It is characterized by severe large-amplitude movements that are classically caused by lesions of the subthalamic nucleus. Given the arterial border zone position of the subthalamic nucleus between the anterior and posterior circulation, hemodynamically compromising carotid stenosis can lead to hypoperfusion in this location.
  
  
  METHODS
  We describe the case of a patient who presented with acute-onset hemiballismus that had complete resolution of symptoms after carotid endarterectomy.
  
  
  CONCLUSIONS
  We suggest that neurovascular imaging should be part of the initial workup of this condition and that prompt diagnosis and treatment of carotid artery stenosis in patients who present with new-onset hemiballismus are essential for reducing risk of imminent stroke.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: jojacob@med.umich.edu.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Joseph
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Delavari
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Wilkinson
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Roark
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000072226:Computed Tomography Angiography; D020820:Dyskinesias / Q000209:etiology*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018608:Ultrasonography, Doppler; D020293:Vasculitis, Central Nervous System; D066127:White Matter / Q000000981:diagnostic imaging
keywords: Carotid stenosis; Endarterectomy; Hemiballismus; Limb shaking; Transient ischemic attack