EpistemisBallism
Specialty: Neurology.
Why it occurs
- Ischemic or hemorrhagic stroke located in the subthalamic nucleus of Luys or its connections
- Nonketotic hyperosmolar metabolic encephalopathy (classic cause of hemichorea-hemibalism in elderly diabetic patients)
- Active demyelinating lesions (multiple sclerosis) in the diencephalon
- Intracranial expansive processes (primary tumors, metastases, brain abscesses in immunosuppressed patients)
- Head trauma with deep focal injury
Initial workup
Emergency cranial MRI (or cranial CT if MRI is not immediately available) to localize ischemic, hemorrhagic, or tumor lesions in the contralateral subthalamic nucleus; Urgent blood analysis with determination of serum glucose and plasma osmolarity (exclusion of hyperosmolar state).
red flags
Unilateral violent ballistic movements of hyperacute onset that compromise the physical stability of the patient, generating severe self-trauma, extreme physical exhaustion, cardiovascular collapse or rhabdomyolysis due to massive and uninterrupted muscle contraction.
Standard management
- Haloperidol — 1-5 mg intramuscularly or intravenously for acute control of violent movement
- Tetrabenazine — 12.5-75 mg/day, medium-term control for dopamine depletion
- Intravenous infusion of saline and insulin to normalize blood glucose and osmolarity in case of hyperglycemic origin
- Clonazepam (0.5-2 mg/day as a sedative adjuvant).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4