Chapter 11 Other abnormal involuntary movements

Video 64 Non-fluent aphasia following intracerebral haemorrhage from a left hemisphere arteriovenous malformation (AVM)

The patient exerts great effort to get any words out, and there are long pauses during which he gesticulates and appears to be frustrated; his sentences are short and easy to understand; his comprehension is normal.

Video 65 Sudden onset of mild left hemiparesis and marked left hemichorea—hemiballismus in a woman with new-onset diabetes mellitus

Brain computed tomography (CT) scan and magnetic resonance imaging showed T1W, T2W and DWI lesions in the right putamen and caudate, consistent with hyperglycaemia-induced hemichorea--hemiballismus. The involuntary movement almost completely resolved with tetrabenazine, a monoamine-depleting drug.

Video 66 Hemiballismus

There are almost continuous irregular coarse jerks of the proximal part of the left arm which persist/increase during hand movement and walking.

Video 67 Tourette’s syndrome

Blinking, grimacing and platysma contraction are seen, particularly when the patient talks.

Video 68 Severe Tourette’s syndrome manifested by complex motor and blocking tics, as well as phonic tics associated with marked obsessive compulsive disorder and self-injurious behaviour

Video 69 Reflex myoclonus

Flicking the fingers of the right hand makes the arm jump. Pricking the fingers causes an exaggerated withdrawal reflex.

Video 70 Post-hypoxic myoclonus

At rest, this patient is still, but when she raises her arms or legs, large-amplitude, shock-like jerks are seen. The jerks interfere with her attempt to touch a pointer, but there is no true intention tremor.

Video 71 Asterixis

The outstretched hands and fingers repeatedly drop and then recover, reflecting a momentary loss of tone.

Video 72 Mini-myoclonus

There are fine, shock-like lateral movements of individual fingers.

Video 73 Palatal and laryngeal myoclonus

Video 74 Athetosis

The fingers of the outstretched right hand make continuous writhing slow irregular movements, each finger moving independently. Similar, low-amplitude movements are seen in the face involving the mouth, eyelids and eyebrows.

Video 75 Generalized dystonia

The patient’s head is turned to the right and the mouth pulls to the left as he talks. The fingers of the left hand are splayed, and the left elbow and wrist are flexed. All actions are interrupted by slow involuntary movements of his limbs and neck.

Video 76 Torticollis

The head is turned to the left and tilted to the right. The posture is corrected by touching the cheeks with either hand (even before the hand touches): geste antagonistique. Even imagining the geste temporarily corrects the posture.

Video 77 Craniocervical dystonia and dystonic—respiratory dysregulation

Video 78 Myoclonus--dystonia syndrome secondary to mutation in the gene coding for ε-sarcoglycan

Video 79 Paroxysmal kinesigenic dystonia

Video 80 Task-specific dystonia in a professional violinist manifested by involuntary left fifth finger flexion and compensatory extension

Video 81 Marked apraxia of eyelid opening

Video 82 Marked stereotypies associated with Rett syndrome

Video 83 Stereotypic behaviour: repeatedly pushing a button on a remote control, and foot and finger tapping, in a right-handed man with progressive dysarthria, apathy, anxiety and mouth drooling

His hand–face stereotypies markedly improved with tetrabenazine, a monoamine-depleting drug.

Video 84 Dopa-induced peak dose dyskinesia

The head tilts initially to the right and then the left. While seated, the patient’s legs and feet move restlessly. While walking, the head tilts to the right and the fingers of the left hand writhe and posture.

Video 85 Chorea in Huntington’s disease

This patient makes constant twitching movements of her hands and feet; she grimaces and her eyebrows dance. All this increases when she talks.

Video 86 Blepharospasm/cranial dystonia

The eyes keep screwing up and there are ‘rabbit twitches’ of the nose and upper lip.

Video 87 End-of-dose dystonia

The patient has a stiff upright posture with no arm swing, walking on the outside of the left foot, with the hallux dorsiflexed.

Video 88 Tardive akathisia

The patient has continuous restless movements of the limbs and is unable to keep still. He also has tardive dyskinesia, and repeatedly protrudes his tongue.

Video 89 Akathisia induced by selective serotonin re-uptake inhibitor

Video 90 Tardive dyskinesia

This patient continually pouts her lips, protrudes her tongue and closes her eyes.

Video 91 Severe oromandibular dystonia with bruxism (constant grinding of the teeth) resulting in extensive dental damage

The symptoms were subsequently controlled with botulinum toxin injections into the masseter and temporalis muscles.

Video 92 Tardive lingual dyskinesia (stereotypy)

Video 93 Typical tardive dyskinesia manifested by orofacial—lingual stereotypy

Video 94 Tardive dystonia

The neck and trunk are hyperextended, except when the patient clasps his hands behind his neck (geste antagonistique).