Abstract

A 78-year-old woman without past relevant medical history presented to the emergency department for acute transient dysarthria. NIHSS was 0/42. Neurological examination revealed chorea-like movements over the left limbs, especially the foot. No other neurological signs were present. CT perfusion showed right cortical hypoperfusion due to right M2 occlusion, basal-ganglia perfusion was normal. Brain MRI revealed a small focus of restricted diffusion in the right insula, sparing basal ganglia. Based on the neuroimaging features and clinical correlation, despite the NIHSS score, we decided to treat the patient with alteplase, after iv-thrombolysis hyperkinetic movements ceased completely. Brain-MRI performed 72 h after symptom onset confirmed a confined insular ischemic lesion without the involvement of deep gray matter structures. Hyperkinetic movement disorders, such as hemichorea hemiballismus, are rare presentations of stroke, basal ganglia are mainly involved even if the insular cortex has been described too. Clinical decision on whether to treat ischemic stroke does not include movement disorders. Our case underscores NIHSS limitations in clinical practice.

中文翻译：

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自由自在（自由自在），自由自在

摘要

一名 78 岁女性，无既往相关病史，因急性短暂性构音障碍到急诊室就诊。NIHSS 为 0/42。神经系统检查发现左肢有类似舞蹈病的运动，尤其是足部。没有其他神经系统症状出现。CT灌注显示由于右侧M2闭塞导致右侧皮质灌注不足，基底节灌注正常。脑部 MRI 显示右侧岛叶有一个扩散受限的小病灶，但基底神经节未受影响。根据神经影像学特征和临床相关性，尽管有 NIHSS 评分，但在静脉溶栓过度运动完全停止后，我们决定用阿替普酶治疗患者。症状出现 72 小时后进行的脑 MRI 证实为局限性岛叶缺血性病变，未累及深部灰质结构。多动性运动障碍，例如偏侧舞蹈症，是中风的罕见表现，即使也描述了岛叶皮质，但主要累及基底神经节。是否治疗缺血性中风的临床决策不包括运动障碍。我们的案例强调了 NIHSS 在临床实践中的局限性。