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Images in Neurology |

Stereotypy After Acute Thalamic Infarct

Sanjay Pandey, DM1; Neelav Sarma, MD1
[+] Author Affiliations
1Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, India
JAMA Neurol. 2015;72(9):1068. doi:10.1001/jamaneurol.2015.0916.
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This Images in Neurology article summarizes clinical features, diagnosis, and management of post-stroke stereotypy.

A man in his 40s presented with sudden-onset slurring of speech and imbalance on walking. On examination, he had difficulty swallowing and required a nasogastric tube for feeding. Six months previously, he had left-sided hemiparesis, which had improved significantly.

On day 5 of admission, we noticed purposeless tapping movements in the patient’s right hand (Video). The movements were repetitive, of the same type, and lasted for 30 seconds to 5 minutes. The patient was able to suppress these movements at will. These movements were not preceded by an urge to perform the movements, and on stopping, there was no development of internal tension to do the movements. These movements were not associated with any change in sensorium or incontinence. The movements slowly decreased in severity, but the pattern remained the same. He was discharged on day 28, when the movements were very mild. At the 1-month follow-up, the movements had almost disappeared. Results of magnetic resonance imaging of the brain (Figure) performed on day 5 showed an acute infarct in the left thalamus and an old infarct in the right gangliocapsular region. The electroencephalogram performed on day 7 showed no abnormalities.

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Magnetic Resonance Imaging of the Brain

There is an acute infarct in the left thalamic region that is isointense on T1 (A), hyperintense on T2 (B), hyperintense on diffusion (C), and hypointense on corresponding apparent diffusion coefficient (D) weighted axial images of the brain. On the right side, there is an old infarct in the right gangliocapsular region.

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Right Hand Stereotypy

Stereotypic movements of the right hand in the form of repeated tapping; the patient is able to stop the tapping when asked to do so. Movements have gradually decreased during 1 month.

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