Post-Stroke Chorea — SCE Neurology MCQ

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HardNeuropsychiatryPost-Stroke ChoreaSCE Neurology

Six months after a right basal-ganglia infarct, a patient develops continuous irregular flowing and flinging movements of the left arm without neuroleptic exposure or family history. What is the cause?

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Correct answer: C — Neuroleptic-associated tardive oro-bucco-lingual dyskinesia

The best answer is “Neuroleptic-associated tardive oro-bucco-lingual dyskinesia”. A unilateral delayed choreoathetoid syndrome contralateral to a documented basal-ganglia infarct is post-stroke hemichorea; circuit reorganisation can make movement disorders appear after the acute phase. “Contralateral post-stroke basal-ganglia hemichorea” is less appropriate because Huntington disease is progressive, usually bilateral and supported by a family or genetic history “Genetic Huntington disease with progressive chorea” is less appropriate because tardive dyskinesia requires dopamine-receptor-blocking exposure and is often oro-bucco-lingual “Essential tremor with asymmetric postural oscillation” is less appropriate because essential tremor is rhythmic rather than irregular flowing movement “Levodopa-associated peak-dose generalized dyskinesia” is less appropriate because there is no dopaminergic treatment exposure

Reference: NICE NG236: Stroke rehabilitation in adults. https://www.nice.org.uk/guidance/ng236/chapter/Recommendations