Transient Hemichorea-hemiballism Induced by a Combination of Postprandial Hypotension and Severe Stenosis of the Innominate Artery Concomitant with Left Carotid Occlusion

Sho Okune; Mikito Hayakawa; Tenyu Hino; Takato Hiramine; Taisuke Akimoto; Masayuki Sato; Yoshiro Ito; Aiki Marushima; Tomoya Takada; Eiichi Ishikawa; Akira Tamaoka; Yuji Matsumaru

doi:10.2169/internalmedicine.0633-22

CASE REPORTS

Transient Hemichorea-hemiballism Induced by a Combination of Postprandial Hypotension and Severe Stenosis of the Innominate Artery Concomitant with Left Carotid Occlusion

Sho Okune, Mikito Hayakawa, Tenyu Hino, Takato Hiramine, Taisuke Akimoto, Masayuki Sato, Yoshiro Ito, Aiki Marushima, Tomoya Takada, Eiichi Ishikawa, Akira Tamaoka, Yuji Matsumaru

Author information

Sho Okune
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
Mikito Hayakawa
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
Tenyu Hino
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Takato Hiramine
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Taisuke Akimoto
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
Masayuki Sato
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
Yoshiro Ito
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
Aiki Marushima
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
Tomoya Takada
Department of Neurosurgery, Kennan Hospital, Japan
Eiichi Ishikawa
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
Akira Tamaoka
Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
Yuji Matsumaru
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan

Keywords: transient ischemic attack, hemichorea-hemiballism, postprandial hypotension, innominate artery stenosis, α-glucosidase inhibitors

JOURNAL OPEN ACCESS
Supplementary material

2024 Volume 63 Issue 4 Pages 577-582

DOI https://doi.org/10.2169/internalmedicine.0633-22

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Abstract

Hemichorea-hemiballism (HCHB) due to transient ischemic attacks (TIAs) is rare. An 83-year-old woman had repeated episodes of right-sided HCHB for 3 months. Magnetic resonance (MR) angiography demonstrated occlusion of the left carotid and middle cerebral arteries and severe stenosis of the innominate artery, and 24-hour ambulatory blood pressure monitoring showed a blood pressure decrease of >20 mmHg after each meal. We speculated that HCHB developed as TIAs due to hemodynamic failure in the left cerebral hemisphere, caused by a combination of severe stenosis of the innominate artery concomitant with occlusion of the left carotid and middle cerebral arteries as well as postprandial hypotension.

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