Davis, Patrick

Patel, Artish

Stepanczuk, Beth, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Post Stroke Focal Aware Seizures Presenting as Delayed Onset Choreoathetosis Artish Patel USF MCOM - LVHN Campus, artish.patel@lvhn.org Patrick Davis USF MCOM - LVHN Campus, patrick.davis@lvhn.org Beth Stepanczuk MD Lehigh Valley Health Network, beth.stepanczuk@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Medicine and Health Sciences Commons Published In/Presented At Patel, A., Davis, P., & Stepanczuk, B. (2021, February 9-13). Post Stroke Focal Aware Seizures Presenting as Delayed Onset Choreoathetosis. [Poster presentation]. Association of Academic Physiatrists Annual Meeting, Virtual. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2021 Lehigh Valley Health NetworkSettingOutpatient follow-up officePatient39-year-old female with history of migraines and recent left parietal temporal intraparenchymal hemorrhage presenting at three-month outpatient follow-up with delayed onset choreoathetosis Post Stroke Focal Aware Seizures Presenting as  Delayed Onset Choreoathetosis Artish Patel, MD, BS, Patrick Davis, MD, BS, and Beth Stepanczuk, MDLehigh Valley Health Network; Allentown, Pa.references: Lanska, Douglas. Early Controversies over Athetosis: I. Clinical Features, Differentiation from other Movement Disorders, Associated Conditions, and Pathology. Tremor and other hyperkinetic movements. 2013; 1.Case DescriptionShe initially presented with acute onset confusion, nausea, vomiting, and aphasia. Imaging revealed acute left parietal temporal intraparenchymal hemorrhage with surrounding edema and restricted diffusion consistent with infarction secondary to superior sagittal sinus thrombosis. On neurological exam, the patient demonstrated moderate receptive and expressive aphasia. Cranial nerve exam suggested right homonymous hemianopsia. Motor exam demonstrated right hemiplegia with proximal movement of right lower extremity. Sensation was decreased in the right hemi-body. The patient progressed well through inpatient rehabilitation  with improvement of right-sided weakness and sensation as well as aphasia. Upon three-month outpatient follow up, the patient endorsed intermittent right arm and hand trembling followed by arm weakness. Examination revealed abrupt onset and cessation of involuntary non-purposeful and writhing right arm movements lasting approximately one-minute suggesting choreoathetosis. Later work up with EEG revealed left parasagittal parietal region abnormalities correlated with  the abnormal movement signifying focal aware seizures. DiscussionThis patient offered a rare case of focal aware seizures presenting as delayed onset choreoathetosis of the right  upper extremity secondary to acute left parietal temporal intraparenchymal hemorrhage. It has been documented that focal aware seizures are not uncommon following acute stroke. However, there have been few reported cases of delayed onset movement disorders such as choreoathetosis following stroke. Finally, there are extremely limited reported cases of patients with these focal aware seizures presenting as delayed onset choreoathetosis following hemorrhagic stroke. ConclusionDespite the rare incidence, focal aware seizures presenting as choreoathetosis should be considered in patients that develop suspected delayed onset movement disorder following acute hemorrhagic stroke. Consideration should be given for proper EEG workup to rule out this rare complication.

Post Stroke Focal Aware Seizures Presenting as Delayed Onset Choreoathetosis

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2862&context=medicine

Post Stroke Focal Aware Seizures Presenting as Delayed Onset Choreoathetosis

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