Transient Involuntary Movement of the Leg (Monoballismus) during Cerebral Angiography

Transient Involuntary Movement of the Leg (Monoballismus) during Cerebral Angiography,Masaki Komiyama,Toshihiro Yasui,Toru Izumi

Transient Involuntary Movement of the Leg (Monoballismus) during Cerebral Angiography  
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Summary: Transient involuntary movement of the leg developed during diagnostic or therapeutic angiography in five patients. The movement was jerky, brisk flexion/extension of the hip and knee joints on the side contralateral to acute ischemia. This move- ment may occur as a result of thromboembolic cerebral ischemia or as an ischemic complication of angiography. seconds during cerebral angiography, with the interval between movements gradually lengthening. The con- sciousness of the patient did not change during the invol- untary movement. Involuntary movements in cases 3 through 5 were re- lated to cerebral ischemia occurring before angiography; they are summarized in the Table. In these cases, endo- vascular treatment for acute cerebral ischemia, either local fibrinolysis or percutaneous transluminal angioplasty, was attempted because the patients were referred to us in the ultraacute ischemic stage. In cases 1 and 2, involuntary movement occurred primarily as a complication of diag- nostic and/or therapeutic cerebral angiography, and they are described in detail. Case 1 This 64-year-old man's history included one occur- rence of a transient ischemic attack, presenting as weak- ness of the right upper limb and lasting a half day. Cerebral angiography disclosed marked stenosis (. 90%) of the petrosal portion of the left internal carotid artery. Cerebral blood flow measurement disclosed diffuse, moderate hy- poperfusion of the left hemisphere. We performed percu- taneous transluminal angioplasty under local anesthesia. Immediately before balloon angioplasty, acute occlusion of the left internal carotid artery occurred, probably be- cause of the reduction in blood flow and the kinking of the proximal internal carotid artery accompanying introduc- tion of the large (8F), stiff guiding catheter. The patient had loss of sensation, followed by weakness, of the right upper limb, especially in the distal portion. This was fol- lowed by the involuntary movement of the right lower limb. Using balloon catheters (Stealth, Target Therapeutics, Fremont, Calif) with inflated balloon diameters of 2.0 and 3.5 mm, respectively, we performed angioplasty at the stenotic portion of the internal carotid artery. Blood flow was restored 40 minutes after the complete cessation of carotid flow. The involuntary movement of the right lower limb soon subsided. The patient recovered completely from weakness and sensory loss in the right upper limb soon after recanalization. No infarction was observed on
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