A man in his 40s presented with sudden-onset slurring of speech and imbalance on walking. On examination, he had difficulty swallowing and required a nasogastric tube for feeding. Six months previously, he had left-sided hemiparesis, which had improved significantly.
On day 5 of admission, we noticed purposeless tapping movements in the patient’s right hand (Video). The movements were repetitive, of the same type, and lasted for 30 seconds to 5 minutes. The patient was able to suppress these movements at will. These movements were not preceded by an urge to perform the movements, and on stopping, there was no development of internal tension to do the movements. These movements were not associated with any change in sensorium or incontinence. The movements slowly decreased in severity, but the pattern remained the same. He was discharged on day 28, when the movements were very mild. At the 1-month follow-up, the movements had almost disappeared. Results of magnetic resonance imaging of the brain (Figure) performed on day 5 showed an acute infarct in the left thalamus and an old infarct in the right gangliocapsular region. The electroencephalogram performed on day 7 showed no abnormalities.
Pandey S, Sarma N. Stereotypy After Acute Thalamic Infarct. JAMA Neurol. 2015;72(9):1068. doi:10.1001/jamaneurol.2015.0916