Teaching Video NeuroImages: Acute hemichorea-hemiballism reverted after IV thrombolysis

A 59-year-old woman was admitted with acute left hemichorea-hemiballism. Blood glucose level was 87 mg/dL. Head CT scan showed old infarcts (figure). The patient underwent thrombolysis with IV alteplase (0.9 mg/kg) within 86 minutes of symptom onset, evolving with partial improvement after 2 hours (video) and complete resolution after 24 hours without other treatments. Brain MRI showed an acute stroke in the right insula (figure), known to be functionally connected to the posterolateral putamen.1 Hemichorea-hemiballism is an uncommon presentation of stroke and may be caused by insular, putaminal, and various other lesions connected to the same network.1,2