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2 - Motor and gestural disorders: Abnormal movement and motor behavior

Published online by Cambridge University Press:  10 October 2009

By
Luc Defebvre  and
Pierre Krystkowiak
Edited by
Olivier Godefroy  and
Julien Bogousslavsky
Luc Defebvre
Affiliation:
Hôpital Salengro, CHRU, France and University Hospital, Lille, France
Pierre Krystkowiak
Affiliation:
Hôpital Salengro, CHRU, France and University Hospital, Lille, France
Olivier Godefroy
Affiliation:
Université de Picardie Jules Verne, Amiens
Julien Bogousslavsky
Affiliation:
Université de Lausanne, Switzerland
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Summary

Introduction

Focal brain lesions can induce several types of abnormal involuntary movement (AIM): dystonia, chorea, hemiballism, tremor, myoclonus, parkinsonism, and asterixis for example (Bhatia and Marsden, 1994; Lee and Marsden, 1994). The most frequent cause is stroke, followed by tumor, trauma, anoxia, vascular malformation, or multiple sclerosis. For some causes (and for stroke in particular), AIM can occur immediately after the brain lesion (for example, hemiballism during the acute phase of the stroke (Destée et al., 1990) whereas initial motor deficit may improve or be recovered rapidly. However, in other situations, AIMs (e.g. dystonia) emerge following a long period (a few months or years) of stable motor impairment (Marsden et al., 1985; Scott and Jankovic, 1996). AIMs can also be subdivided into transient (hemiballism, often in the acute phase) and persistent (dystonia, tremor, etc.). Whatever their timescales of appearance or disappearance, AIM may be the main symptom of stroke. This induces a delay in diagnosis or even a lack of knowledge of the specific diagnosis, since for the same underlying cause, the type of AIM can be quite different. This problem is sometimes clinically evident when the AIM is intense (hemiballism) or, in contrast, very moderate and focalized (asterixis). It is clear that a delay in diagnosis may have unhelpful consequences in terms of the patient's clinical and therapeutic management.

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Information
The Behavioral and Cognitive Neurology of Stroke , pp. 15 - 35
Publisher: Cambridge University Press
Print publication year: 2007

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