Objective: To prove that pallidotomy can be an alternative therapy for intractable chorea.

Background: A 61 year old woman come with complaint sudden irregular movement in left arm and leg. Previously she had history transsphenoid operation for pituitary adenoma twice. But still there is residual tumor due to difficult location. For 2 years after the operation she has no complaint except bitemporal hemianopia. Suddenly she come with irregular movement (left hemichorea). Her blood sugar raised until 515 mg/dL. MRI T2 FLAIR showed that there was hyperintensities in right basal ganglia. Her hyperglicemia condition can be controlled by using insulin and we started to give haloperidol to this patient. After a month, we didn’t see any improvement on chorea and we increased the dosage and we add valproic acid. 3 months later, the condition was still the same. We planned to do pallidotomy for this patient.

Methods: This is a case report that we ever perfomed in Siloam Hospital Kebon Jeruk. We did pallidotomy in the right basal ganglia.

Results: After pallidotomy was done, we didn’t see any abnormal movement but we found complication. She get hemiplegia. We performed head CT and we got bleeding in lesioning place. We refered patient to physiotherapy. We doubt that the hemiplegia was the bleeding effect or maybe due to the hyperglicemia effect. A week after the operation patient looked depress and less of motivation. we gave escitalopram. A month after operation, patient showed a lot of improvement. Patient can walk and has better mood. We decrease medication dosage. After 3 months we stopped all the medication and patient can walk normally without any abnormal movement and has a normal mood.

Conclusions: Pallidotomy can be an alternative treatment for intractable chorea.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pallidotomy-for-intractable-hemichorea-in-sudden-hyperglicemic-pituitary-adenoma-patient/