Paroxysmal Hemidyskinesia Related to a Large Thalamic Cyst

Yara Dadalti Fragoso, MD, MSc, PhD; Mauro Gomes Araujo, MD

Disclosures

February 14, 2007

In This Article

Introduction

Symptomatic thalamic lesions are more frequently related to stroke, usually causing contralateral sensory symptoms, and less often to contralateral movement disorders. Thalamic lesions leading to movement disorders have been reported in cases of multiple sclerosis, perinatal injury, AIDS, thyroid and parathyroid abnormalities, basal ganglia calcification, cystinuria, encephalitis, meningioma, and Leigh syndrome. These causes of dyskinesias are relatively rare, and only a few isolated cases have been described and reviewed during the last 3 decades.[1,2]

Sporadic paroxysmal dyskinesia (PDK) may be an even less frequent clinical presentation of structural lesions of the thalamus. In a classic series of 62 patients with thalamic and subthalamic lesions, only 3 presented clinically with PDK with contralateral dystonia: Two were related to stroke and 1 was related to multiple sclerosis.[1] The attacks were precipitated by voluntary movements in all patients. All cases had discrete focal lesions in the posterolateral or ventrolateral thalamus, with involvement of the internal capsule.[1]

We report a case of an adolescent who developed PDK with a mixed presentation of paroxysmal nonkinesigenic dyskinesia (PNKD) and paroxysmal hypnogenic dyskinesia (PHD) restricted to the hand and foot, particularly in the fingers and toes, with an unusually high number of attacks per day and night. Radiologic investigation showed a large thalamic cyst, contralateral to the hemidyskinesia. To the best of our knowledge, there are no similar cases in the literature.

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