AccScience Publishing / AN / Volume 2 / Issue 1 / DOI: 10.36922/an.v2i1.141
Cite this article
Journal Browser
Volume | Year
News and Announcements
View All

Choreoathetosis of the upper limb with contralateral substantia nigra lacunar infarction: A case report and literature review

Mengxin Li1 Xiaojun Zhang1 Yanqiang Wang1
Show Less
1 Department of Neurology Ⅱ, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
Advanced Neurology 2023, 2(1), 141
Submitted: 25 June 2022 | Accepted: 9 January 2023 | Published: 27 January 2023
© 2023 by the Author(s). Licensee AccScience Publishing, Singapore. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Choreoathetosis of the upper limb as the first manifestation of contralateral substantia nigra (SN) lacunar infarction is extremely rare. We report a case of choreoathetosis of the right upper limb in a 60-year-old man with SN infarction. Emergency brain magnetic resonance imaging showed discrete lacunar infarction localized in the left SN. Magnetic resonance angiography showed atherosclerotic stenosis of the basilar artery and the left posterior cerebral artery. He was diagnosed with contralateral SN infarction and then treated with antiplatelet, loading-dose statins, and allopathic therapy to achieve a positive outcome. During the follow-up period, there was no recurrence of stroke, and his symptom of choreoathetosis resolved. More cases alike should be studied to achieve satisfactory outcomes through early diagnosis and appropriate treatments.

Substantia nigra
Dance-like movements
Ischemic stroke
Yuandu scholars
Weifang Key Laboratory

Defebvre L, Krystkowiak P, 2016, Movement disorders and stroke. Rev Neurol (Paris), 172: 483–487.


Alarcón F, Zijlmans JC, Dueñas G, et al., 2004, Post-stroke movement disorders: Report of 56 patients. J Neurol Neurosurg Psychiatry, 75: 1568–1574.


Tater P, Pandey S, 2021, Post-stroke movement disorders: Clinical spectrum, pathogenesis, and management. Neurol India, 69: 272–283. 


Sonne J, Reddy V, Beato MR, 2022, Neuroanatomy, substantia nigra. StatPearls Publishing, Treasure Island.


Morgan JC, Sethi KD, 2003, Midbrain infarct with Parkinsonism. Neurology, 60: E10.


Robles LA, 2016, Pure Hemi-Parkinsonism secondary to contralateral lacunar stroke in the substantia nigra. J Stroke Cerebrovasc Dis, 25: e20–e21.


Ohta K, Obara K, 2006, Hemi-Parkinsonism with a discrete lacunar infarction in the contralateral substantia nigra. Mov Disord, 21: 124–125.


Hunter R, Smith J, Thomson T, et al., 1978, Hemi- Parkinsonism with infarction of the ipsilateral substantia nigra. Neuropathol Appl Neurobiol, 4: 297–301.


Kim HA, You S, 2017, Akinetic mutism in a patient with acute infarcts in the bilateral substantia nigra. J Neurol Sci, 373: 46–47.


Daniel SJ, Ulises RO, 2008, Stroke of the substance nigra and Parkinsonism as first manifestation of systemic lupus erythematosus. Parkinsonism Relat Disord, 14: 367–369.


Gonzalez-Alegre P, 2007, Monomelic parkinsonian tremor caused by contralateral substantia nigra stroke. Parkinsonism Relat Disord, 13: 182–184.


Akyol A, Akyildiz UO, Tataroglu C, 2006, Vascular Parkinsonism: A case of lacunar infarction localized to mesencephalic substantia nigra. Parkinsonism Relat Disord, 12: 459–461.


Caparros-Lefebvre D, Deleume JF, Bradai N, et al., 1994, Biballism caused by bilateral infarction in the substantia nigra. Mov Disord, 9: 108–110. 


McKee AC, Levine DN, Kowall NW, et al., 1990, Peduncular hallucinosis associated with isolated infarction of the substantia nigra pars reticulata. Ann Neurol, 27: 500–504.


Irioka T, Ayabe J, Mizusawa H, 2010, Hemichorea improved by extracranial-intracranial bypass surgery for middle cerebral artery occlusion. J Neurol, 257: 1756–1758.


Park J, 2016, Movement disorders following cerebrovascular lesion in the basal ganglia circuit. J Mov Disord, 9: 71–79.


Dorst MC, Tokarska A, Zhou M, et al., 2020, Polysynaptic inhibition between striatal cholinergic interneurons shapes their network activity patterns in a dopamine-dependent manner. Nat Commun, 11: 5113.


Brannan T, Weinberger J, Knott P, et al., 1987, Direct evidence of acute, massive striatal dopamine release in gerbils with unilateral strokes. Stroke, 18: 108–110.


Haba K, Ogawa N, Mizukawa K, et al., 1991, Time course of changes in lipid peroxidation, pre-and postsynaptic cholinergic indices, NMDA receptor binding and neuronal death in the gerbil hippocampus following transient ischemia. Brain Res. 540: 116–122. 


Muhammad A, Bielskute E, Guyler PC, et al., 2019, Acute ischaemic stroke-related choreoathetosis treated with arterial thrombectomy. BMJ Case Rep, 12: e226035.

Conflict of interest
The authors declare they have no competing interests.
Back to top
Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: TBA, Published by AccScience Publishing