Management of Acute Movement Disorders

Figure 91.1. Sequence of photographs showing involuntary movements in a patient with acute thalamic stroke, with flexion and external rotation of the lower limbs and eversion of both feet (myoclonic dystonia).

Involuntary motor phenomena with varied presentation have been reported in ischemic lesions of the brainstem. They can range from small amplitude movements similar to myoclonus to shaking of the limbs and even the trunk, which are often intermittent and can be triggered by painful stimuli. Their frequency is unknown, but they usually occur in extensive lesions of the brainstem usually related to acute basilar occlusion [16]. The pathophysiology is uncertain and the most likely is the corticospinal tract ischemia. Recognition of these movements, and consequent measures for quick diagnosis and treatment, are important because they may suggest the formation of a basilar occlusion.

91.9 Conclusions

In patients accessing the emergency room with a movement disorder of acute onset, clinical manifestations and etiology may be various. In such cases we must evaluate the autonomic disorders that may accompany the clinical features and establish the therapeutic measures that can sometimes require ICU admission (Figure 91.2).

Figure 91.2. Algorithm for emergency management of acute movement disorders.

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