Presentation
Right-sided choreiform movements.
Patient Data
Small intraparenchymal haemorrhage in the left subthalamic nucleus.
There is an area of gliosis/encephalomalacia within the left frontal lobe, and further smaller areas of gliosis within the right frontal lobe, right parietal lobe, and the right cerebellar hemisphere, consistent with established infarcts in these areas. Further small areas of CSF density are seen in the corona radiata/centrum semiovale bilaterally, consistent with further established lacunar infarcts.
There is moderate generalised cerebral atrophy, with compensatory ventriculosulcal dilatation. There are semi-confluent areas of hypoattenuation in the periventricular white matter, consistent with significant small vessel change.
Unremarkable appearances of the basal cisterns, soft tissue structures , and paranasal air sinuses. Left sided otomastoiditis.
Case Discussion
The subthalamic nucleus (STN) is part of the basal ganglia system and projects neurones to the globus pallidus internus. Unilateral disease of the subthalamic nucleus, such as due to intraparenchymal haemorrhage as in this case, can result in contralateral hemichorea-hemiballismus syndrome.
The subthalamic nucleus is also involved in other pathologies. Notably, deep brain stimulation of the subthalamic nucleus can be used to treat idiopathic Parkinson disease. The subthalamic nucleus has also been hypothesised to play a rule in impulsive behaviour therefore implicated in obsessive compulsive disorder.
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