Lower limb monochorea from a globus pallidus infarct

Movement disorders are common following cerebrovascular accidents and they can be hyperkinetic, including hemichorea and hemiballismus, or hypokinetic, as seen in parkinsonian disorders. Monochorea has also been reported due to stroke, albeit rarely. We report a 47-year-old gentleman who presented with a history of sudden onset choreiform movement of his left lower limb. On clinical examination his motor power was normal and there were no abnormal movements in any other limb. MRI of his brain was suggestive of an infarct in the right globus pallidus interna extending up to the posterior limb of the internal capsule. He was treated with clonazepam and trihexyphenidyl. His movements improved significantly within 3 months. Monochorea in a lower limb due to an infarct in the globus pallidus interna is unusual and highlights the complexity of the pathophysiology of chorea. (C) 2014 Elsevier Ltd. All rights reserved.