Objective: To report a case with bilateral hand stereotypy after left cerebellar infarction

Background: Stereotypy is defined as repetitive and continuous non-goal-directed movement. It was reported in association with various disorders including developmental delay, autism, schizophrenia, tardive dyskinesia, and frontotemporal dementia. There were few cases with stereotypy secondary to cerebral infarctions in the putamen or cerebellum.

Methods: This is a case report.

Results: An 82-year-old man was admitted to the hospital with acute onset dysarthria and gait disturbance. A neurological examination showed normal cognition, dysmetria, and gait ataxia. Brain magnetic resonance imaging (MRI) showed an acute infarction in the left cerebellar hemisphere. Three weeks after the cerebellar infarction, abnormal movements of the bilateral hands developed. He continuously rubbed both thumbs against the index fingers. The movements were temporarily suppressible on demand or decreased when he was distracted. There was no urge to move his hands when he was holding the movements. A follow-up neurological examination showed asymmetric bradykinesia without postural instability in addition to stereotypic movements. Follow-up neuroimaging studies were performed which revealed multiple areas of hypometabolism including the bilateral high frontal cortex, anterior temporal cortex, anterior cingulate gyrus, and left cerebellum using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), and decreased uptake in both putamen and caudate nuclei using 18F-fluorinated N-3-fluoropropyl-2-beta-carboxymethoxy-3-beta-(4-iodophenyl) nortropane (18F-FP-CIT) PET.

Conclusions: The abnormal movements were continuous, patterned, and distractible. Without sensory urge, the movements can be best classified as stereotypy. This is another illustrative case study revealing the important role of the cerebellum in stereotypy. Cerebellar stereotypy is a unique clinical syndrome providing a new insight on the pathophysiology of stereotypy.

References: [1] D. Lee, D. Lee, T.B. Ahn (2014) Stereotypy after cerebellar infarction. J Neurol Sci. 344 227-228.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/bilateral-stereotypy-after-unilateral-cerebellar-infarction/