RESIDENT & FELLOW SECTION Teaching Video NeuroImages: Acute hemichorea-hemiballism reverted after IV thrombolysis Caio Disserol, MD, Bárbara Alencar, MD, Jacy Parmera, MD, Adriana Bastos Conforto, MD, PhD, and Lécio Figueira Pinto, MD, PhD ® Neurology 2020;94:e121-e122. doi:10.1212/WNL.0000000000008706 Correspondence Dr. Disserol caio.disserol@hc.fm.usp.br Figure Imaging Head CT scan shows old infarcts (A) and brain MRI shows an acute stroke involving the right insular cortex and capsula extrema on diffusion-weighted (B), apparent diffusion coefficient map (C), and fluid-attenuated inversion recovery (D) images. A 59-year-old woman was admitted with acute left hemichorea-hemiballism. Blood glucose level was 87 mg/dL. Head CT scan showed old infarcts (figure). The patient underwent thrombolysis with IV alteplase (0.9 mg/kg) within 86 minutes of symptom onset, evolving with partial improvement after 2 hours (video) and complete resolution after 24 hours without other treatments. Brain MRI showed an acute stroke in the right insula (figure), known to be functionally connected to the posterolateral putamen.1 Hemichorea-hemiballism is an uncommon presentation of stroke and may be caused by insular, putaminal, and various other lesions connected to the same network.1,2 MORE ONLINE Video Teaching slides links.lww.com/WNL/ B19 Study funding No targeted funding reported. Disclosure The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures. References 1. 2. Laganier S, Boes A, Fox M. Network localization of hemichorea-hemiballismus. Neurology 2016;86:2187–2195. Bembenek JP, Bilik M, Członkowska A. Successful treatment with intravenous recombinant tissue plasminogen activator in an acute stroke patient presenting with hemiballism. Funct Neurol 2015;30:71–72. From the Department of Neurology, Hospital das Clı́nicas, University of São Paulo Medical School, Brazil. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. Copyright © 2019 American Academy of Neurology Copyright © 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. e121 Appendix Authors e122 Name Location Role Contribution Caio Disserol, MD Hospital das Clı́nicas, University of São Paulo Medical School Author Wrote the manuscript, data collection, analysis, and interpretation Bárbara Alencar, MD Hospital das Clı́nicas, University of São Paulo Medical School Author Data collection, analysis, and interpretation Jacy Parmera, MD Hospital das Clı́nicas, University of São Paulo Medical School Author Conceptualization of the study, interpretation of the data, revision of the manuscript Adriana Bastos Conforto, MD, PhD Hospital das Clı́nicas, University of São Paulo Medical School Author Interpretation of the data, revision of the manuscript Lécio Figueira Pinto, MD, PhD Hospital das Clı́nicas, University of São Paulo Medical School Author Conceptualization of the study, interpretation of the data, revision of the manuscript Neurology | Volume 94, Number 1 | January 7, 2020 Neurology.org/N Copyright © 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Teaching Video NeuroImages: Acute hemichorea-hemiballism reverted after IV thrombolysis Caio Disserol, Bárbara Alencar, Jacy Parmera, et al. Neurology 2020;94;e121-e122 DOI 10.1212/WNL.0000000000008706 This information is current as of December 30, 2019 Updated Information & Services including high resolution figures, can be found at: http://n.neurology.org/content/94/1/e121.full References This article cites 2 articles, 1 of which you can access for free at: http://n.neurology.org/content/94/1/e121.full#ref-list-1 Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): All Cerebrovascular disease/Stroke http://n.neurology.org/cgi/collection/all_cerebrovascular_disease_strok e Chorea http://n.neurology.org/cgi/collection/chorea MRI http://n.neurology.org/cgi/collection/mri Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/about/about_the_journal#permissions Reprints Information about ordering reprints can be found online: http://n.neurology.org/subscribers/advertise Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2019 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.