Choreoathetosis after subarachnoid hemorrhage Pereira JLB et al. CLINICS 2011;66(9):1655-1657 A B Figure 1 - A) Cerebral angiography at admission revealed a small saccular aneurysm of the basilar artery near the emergence of the anterior inferior cerebellar artery (AICA). B) T2-weighted Magnetic Resonance Imaging (MRI) at the one-year follow-up revealed cerebellar atrophy. Table 1 - Movement disorders after SAH. Author (Year) Sakai et al. (1991)4 Alarco´ n et al. (2004)3 Alarco´ n et al. (2004)3 Alarco´ n et al. (2004)3 Morigaki et al. (2008)5 Pereira et al. (2011) Age Sex 71 74 55 63 72 17 F F F F F M MD Chorea Tremor Tremor Tremor, dystonia, ataxia and dysmetria Choreoathetosis Choreoathetosis Time from SAH to MD 8 days * * * Ictus Ictus Aneurysm localization ICA - AchoA ** ** ** Distal accessory ACA Basilar artery at AICA emergence MD Recovery Total Hypothesis Vasospasm Hydrocephalus ** ** ** Total Total Intraventricular hemorrhage Hydrocephalus Hydrocephalus Corpus callosum hematoma Disturbance of the dentato- rubro-thalamo-cortical pathways F = female; M = male; MD = movement disorder; AICA = anterior inferior cerebellar artery; ICA – AchoA = internal carotid artery - anterior choroidal artery; ACA = anterior cerebral artery. *Only time in days (18.7 days, SD = 12.8 days) reported between the diagnosis of stroke and the onset of abnormal movements in a group of 14 patients with tremor after stroke. Six patients experienced an ischemic stroke, five had parenchymal hemorrhage, and three experienced a subarachnoid hemorrhage. **not mentioned. cases in which the abnormal movement occurred much later, including Parkinsonism that began ten months after the stroke.3 While analyzing the literature data on movement dis- orders after a SAH (Table 1), we observed a total of six patients (including this reported case). Of these six patients, five were female and one was male, with a mean age of 58.6 years (SD 21.6, ranging from 17 to 74 years). Chorea or choreoathetosis was observed in three of these cases; tremor was observed in the other three cases. One patient in the tremor group exhibited associated dystonia. Our case is very atypical because he is the youngest patient ever described and was the only male to present with SAH- related involuntary movement. In our case, no vasospasm, hydrocephalus, or even direct injury to the basal ganglia was observed that could explain the choreoathetosis. We suggest that the hematoma that was located in the fourth ventricle may have disturbed the dentato-rubro-thalamo-cortical pathways, leading to transi- ent choreoatetoid movements. Another hypothesis, without evidence of a vasospasm, is that the movement disorder was secondary to an ischemic lesion in the thalamogeniculate artery (a branch of the posterior cerebral artery), which disturbed the posterior ventral thalamic areas related to the basal ganglia circuit. REFERENCES 1. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355:928-39, doi: 10.1056/NEJMra052760. 2. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354:387-96, doi: 10.1056/NEJMra052732. 3. Alarco´n F, Zijlmans JCM, Due n˜as G, Cevallos N. Post-stroke movement disorders: report of 56 patients. J Neurol Neurosurg Psychiatry. 2004;75:1568–74, doi: 10.1136/jnnp.2003.011874. 1656