SHM Converge Scientific Abstract ePoster Gallery-Psychiatric Manifestations in Vascular Hemiballismus: A Case Study

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This case report describes a 67-year-old woman who developed sudden left-sided involuntary jerking movements, facial droop, and slurred speech after an acute ischemic lacunar stroke in the basal ganglia. MRI confirmed the stroke, and neurology diagnosed vascular hemiballismus, a rare movement disorder usually caused by damage to the subthalamic nucleus or related basal ganglia pathways.<br /><br />What made this case unusual was that the patient seemed to have partial control over her movements. The symptoms worsened with stress, improved with relaxation, and could be partly suppressed with distraction. Because of these features, clinicians suspected a possible psychiatric or functional overlay in addition to the stroke-related neurologic disorder. Her recent life stressors included marriage, caregiving duties, and relocation.<br /><br />The authors propose that this case challenges the traditional view of hemiballismus as purely involuntary. They suggest that emotional state may have influenced cerebral blood flow or neurotransmitter activity, temporarily affecting inhibitory GABAergic pathways in the basal ganglia. In this model, stress could have increased sympathetic activity and vasoconstriction, while relaxation may have supported better blood flow and partial symptom suppression.<br /><br />The patient was treated with benztropine and advised to follow up with a movement disorder specialist.<br /><br />Overall, the report highlights that vascular hemiballismus may occasionally have a mixed neurologic and psychogenic presentation. Clinicians should consider psychological factors when symptoms show variability with stress or relaxation, and further research is needed on how emotional state may affect movement disorders.

Asset Subtitle

Jonathan D. Grube

Meta Tag

Author List Alexander Thompson, Anish Khanna, Brando to, Dennis Rivera Lopez, Jonathan D. Grube, Kathleen Mattingly, Kenneth Hackbarth, Kiven Ramos Vega

Category Clinical Vignettes

Concept Nonketotic Hyperglycemic Hemichorea/Hemiballismus

Concept Involuntary Movement

Concept Subthalamic nucleus

Concept Stroke

Concept GABA

Distinguished Non-Finalist

Presenter Organization UCF/HCA Ocala Internal Medicine Residency

Presenting Author Jonathan D. Grube

Track Adult

Keywords

vascular hemiballismus

basal ganglia stroke

lacunar ischemic stroke

involuntary jerking

facial droop

slurred speech

functional overlay

stress-related symptoms

benztropine treatment

GABAergic pathways

Nonketotic Hyperglycemic Hemichorea/Hemiballismus

Involuntary Movement

Subthalamic nucleus

Stroke

GABA