Objective: To present a rare case of chorea and dystonia development in a young patient following cardiac arrest.

Background: An hypoxic brain injury can potentially cause several neurological complications, depending on the afflicted areas of the brain. The occurrence of movement disorders in this context has long been recognized, but most frequently in the form of tremor or myoclonus. Albeit rarely, choreiform movements and dystonia can develop after an hypoxic brain injury.

Method: Case report – retrospective chart review.

Results: We hereby present the case of a 52-year-old woman, with dyslipidemia and Crohn disease, who suffered from cardiac-arrest in the setting of primary ventricular fibrillation. At the fourth day of hospitalization at the intermediate medical care unit, the patient developed choreiform movements involving all four limbs, slightly more prominent in the right, and cervical dystonia with left laterocollis. A careful revision of the prescribed medication was performed and metoclopramide was immediately discontinued; no other potentially offending drugs were identified. At that moment, the patient had already been submitted to two head-CT scans, one immediately after admission and another one 48h later, and neither exhibited acute lesions. An urgent brain magnetic resonance showed bilateral and symmetrical hyperintense signal localized to the globus pallidus in the T2-weighted sequence, congruent with an hypoxic-ischaemic lesion. The patient was started on biperiden, which provided only a slight improvement. Tetrabenazine was then slowly titrated with partial response and the patient was discharged to a rehabilitation centre.

Conclusion: With this case report we aim to emphasize that despite rare, chorea can be the main manifestation of an hypoxic brain injury and its recognition is of uttermost importance, avoiding misdiagnosis with the more frequent status epilepticus in the post-anoxic patient, and prompting the beginning of appropriate treatment for controlling this hypekinetic disorder, as well as an adequate rehabilitation program.

References: Moon D. Disorders of Movement due to Acquired and Traumatic Brain Injury. Curr Phys Med Rehabil Reports. 2022;10(4):311. doi:10.1007/S40141-022-00368-1
Scheibe F, Neumann WJ, Lange C, et al. Movement disorders after hypoxic brain injury following cardiac arrest in adults. Eur J Neurol. 2020;27(10):1937-1947. doi:10.1111/ENE.14326
Ghasemi M, Kaddouh F, Deb A, Owegi MA. Delayed-onset MRI findings in acute chorea related to anoxic brain injury. Clin Imaging. 2018;48:22-25. doi:10.1016/j.clinimag.2017.10.004
Venkatesan A, Frucht S. Movement disorders after resuscitation from cardiac arrest. Neurol Clin. 2006;24(1):123-132. doi:10.1016/J.NCL.2005.11.001

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hypoxic-brain-injury-a-rare-cause-of-chorea-and-dystonia/