Abstract
We report a case of acute hemichorea associated with lacunar infarction in the head of caudate nucleus and the genu of internal capsule. The patient was a 61-year-old man who underwent superficial temporal artery and middle cerebral artery (STA-MCA) anastomosis for high degree internal carotid aretry stenosis, and his symptoms continued chronically. The symptoms improved shortly after surgery and disappeared thereafter, and this patient has been asymptomatic for 4 years until now. When test findings were compared between before and after surgery, favorable patency in the anastomotic blood vessels was observed by angiography, and improvement of the cerebral blood flow (CBF) which extensively decreased mainly in the affected cerebral hemisphere were observed by CBF measurement. It is known that acute hemichorea is caused by infarction of the caudate nucleus, etc., and its mechanism is considered to be due to disorder of the accommodation in the excitation and inhibition systems connecting the putamen, caudate nucleus, globus pallidus, thalamus, subthalamic nucleus and cerebral cortex. It was considered that this case was cured because accommodation system of the involuntary movement was controlled by improvement of the CBF due to the vascular anastomosis.
