Objective: To describe delayed hyperkinetic movement disorder after a thalamic lesion.

Background: Lesions in the basal ganglia circuit can cause abnormal movement disorders.  After thalamic lesions, acute onset abnormal movements are common, but delayed onset are rare (2). Delayed abnormalities can occur from degeneration and plastic changes of tracts connected to the thalamus (3). Reports are infrequent and further case series will help to understand the clinical spectrum of these lesions. 
 
Case1: A 56-year-old woman with a benign brain tumor resection affecting the thalamus years later developed left upper limb dysmetria, tremor, athetosis, and dystonic posturing. She also had absent vibration and proprioception in left upper limb.  
 
Case 2: A 69-year-old man with left thalamic stroke two years later developed constant slow, writhing athetosis and pseudoathetosis in hand and choreic, tremulous right thumb movements. He also had reduced proprioception in the face. 
 
Case 3: A 56-year-old man with a right thalamic infarct presented years later with left upper limb irregular athetotic finger movements, dystonia, and choreathetotic movements. He had decreased vibration and proprioception on the left side. 
 
Case 4:   A 62-year-old man with a right thalamic hemorrhagic stroke presented one year later with left upper limb arrhythmic dystonic posturing of the hand, tremor, clumsiness on rapid alternating movement, and burning pain on the left side of his body.

Method: This is a case series. 
 
 

Results: In our cases dystonia and athetosis were most commonly observed; tremor, choreoathetosis and pseudoathetosis were also observed. Most of the patients also had abnormal proprioception. This is similar as described in literature. Three patients underwent medical management with improvement in pain but not in abnormal movements. One had deep brain stimulation with transient improvement in movement symptoms that later returned.  

Conclusion: Delayed onset involuntary movements secondary to thalamic lesions continue to be underrepresented in the literature. Currently our understanding of the semiology and pathophysiology of these movements is scarce. Further case reports will aid to better understand the clinical characteristics of this disorder. Furthermore, a better understating of the movement semiology will lead us to eventually develop more targeted treatment schemes for this entity. 
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MDS Abstracts - https://www.mdsabstracts.org/abstract/hyperkinetic-movement-disorders-after-thalamic-lesions/