- Department of Neurosurgery, Kumamoto General Hospital, Yatsushiro, Japan.
- Department of Neurosurgery, Amakusa Medical Center, Amakusa, Japan.
- Division of Speech-Language and Hearing Therapy, Faculty of Health Science, Kumamoto Health Science University, Kita-Ku, Japan.
- Department of Neurosurgery, Kumamoto Neurosurgical Hospital, Chuo-Ku, Kumamoto, Japan.
Correspondence Address:
Hirotaka Inoue
Department of Neurosurgery, Kumamoto General Hospital, Yatsushiro, Japan.
DOI:10.25259/SNI_171_2021
Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Hirotaka Inoue1, Rihito Yamamura2, Kazumichi Yamada3, Tadashi Hamasaki1, Nobuhiro Inoue4, Akitake Mukasa1. Hemichorea induced by a sphenoid ridge meningioma. 03-May-2021;12:201
How to cite this URL: Hirotaka Inoue1, Rihito Yamamura2, Kazumichi Yamada3, Tadashi Hamasaki1, Nobuhiro Inoue4, Akitake Mukasa1. Hemichorea induced by a sphenoid ridge meningioma. 03-May-2021;12:201. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10787
Abstract
Background: Movement disorders are rare in brain tumors. We describe a 45-year-old woman with hemichorea, a concomitant contralateral sphenoid ridge meningioma.
Case Description: The meningioma enlarged as her hemichorea worsened, and after meningioma resection, the hemichorea gradually subsided. N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography performed preoperatively showed decreased regional cerebral blood flow (CBF) to the basal ganglia circuit ipsilateral to the tumor and, when repeated postoperatively, confirmed improved regional CBF.
Conclusion: We propose that the enlarging sphenoid ridge meningioma had a remote effect on regional CBF and the thalamocortical motor center and that complex changes in the basal ganglia output may have caused the hemichorea.
Keywords: Cerebral blood flow, Chorea, Meningioma, Remote effect
INTRODUCTION
Chorea is defined as a hyperkinetic movement disorder, characterized by involuntary, brief, random, and irregular muscle contractions.[
CASE PRESENTATION
Our patient was a 45-year-old woman who experienced twitching of the left lip, anarthria, and abnormal movements involving the distal part of her left limb 2 years previously. A diagnosis of chorea was made after consultation with the department of neurology, and the symptoms failed to improve despite administration of clonazepam. A small meningioma arising from the right sphenoid ridge was discovered. The meningioma enlarged over time [
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Figure 2:
N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT) performed before surgery (upper panels) demonstrates decreased regional cerebral blood flow to the right ventral midbrain, thalamus (arrows), and frontotemporal lobe cortex. SPECT performed 5 months after surgery (lower panels) reveals a slight improvement.
DISCUSSION
Hemichorea generally occurs as a complication of a vascular malformation, basal ganglia tumor, stroke, metastasis, or metabolic disorders.[
We believe that the meningioma caused hemichorea in our patient for the following reasons. First, the laterality of hemichorea corresponded to the tumor location. Second, the hemichorea worsened when the meningioma increased in size, and subsided after surgery, while the APS worsened throughout this period. Third, after tumor resection, the reduced CBF in the midbrain and thalamus normalized.
Movement disorders are rare clinical features of brain tumors.[
We used the Alexander and Crutcher model to determine the causal association of CBF change and hemichorea.[
CONCLUSION
Herein, we report a rare case of hemichorea induced by a sphenoid ridge meningioma. The symptoms underwent remission after resection of the tumor. We believe that the growing meningioma had a remote effect, altering the firing pattern of the thalamocortical motor pathways and leading to the manifestation of hemichorea. APS can also cause hemichorea; however, the status of the APS in our patient did not correlate with her clinical course.
Ethical approval
The authors confirm that the approval of an Institutional Review Board was not required for this work. Written informed consent for the publication of this report was obtained from the patient, and this report does not identify the individual. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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