Hemiballismus and choreoathetosis as a relapse in multiple sclerosis: A case report and review of literature

Abstract

Introduction. Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS). In contrast to tremor, which is frequently observed in MS patients, other movement disorders including Parkinsonism, dystonia, chorea, ballism, myoclonus, and hemifacial spasm rarely occur. Case report. The patient is a 34-year-old woman, a known case of MS manifested with choreiform movements in the tongue in conjunction with right upper and lower extremities choreoathetosis and hemiballismus. Magnetic resonance imaging (MRI) depicted a plaque in the contralateral subthalamic nucleus. The patient was treated with pulse methylprednisolone, antipsychotic and dopamine receptor blocker medications with complete recovery of her symptoms within one month. Conclusions. Chorea or ballismus occur rarely as the presenting or relapsing features in MS patients. Therefore, clinicians should be familiar with this possibility and include high resolution neuroimaging and EEG in the diagnostic work-up of patients with MD to avoid misdiagnosis and inappropriate management.

Keywords

• multiple sclerosis
• hemiballismus
• choreoathetosis
• subthalamic nucleus
• dyskinesias