A 72-year-old woman who experienced a postoperative stroke after a carotid endarterectomy with the presenting symptom of hemiballismus is described. This unusual presentation was likely the result of a hypotensive episode coupled with a predisposing anatomic variant in the circle of Willis, which compromised blood flow in the posterior cerebral circulation. She responded well to treatment with haloperidol with complete resolution of hemiballistic movements.
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References
1.
1. Biller J, Feinberg WM, Castaldo JE, et al: Guidelines for carotid endarterectomy. A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Circulation97:501-509, 1998.
6. Klawans HL, Moses H, Nausieda PA, et al: Treatment and prognosis of hemiballismus. N Engl J Med295:1348-1350.
7.
7. Martin JP, McCaul IR: Acute hemiballismus treated by ventrolateral thalamolysis. Brain82:104-108, 1959.
8.
8. Suarez JI, Verhagen ML, Reich SG, et al: Pallidotomy for hemiballismus: Efficacy and characteristics of neuronal activity. Ann Neurol42:807-811, 1997.
9.
9. Asiddao CB, Donegan JH, Whitesell RC, et al: Factors associated with perioperative complications during carotid endarterectomy. Anesth Analg61:631-637, 1982.
10.
10. Hertzer NR: Postoperative management and complications following carotid endarterectomy. In: Vascular Surgery, ed. by Rutherford RB. Philadelphia: WB Saunders, 1995, pp 1637-1659.
12. Skudlarick JL, Mooring SL: Systolic hypertension and complications of carotid endarterectomy. South Med J75:1563-1565, 1982.
13.
13. Bove EL, Fry WJ, Gross WS, et al: Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy. Surgery85:633-637, 1979.
15. Wong JH, Findlay JM, Suarez-Almazor ME: Hemodynamic instability after carotid endarterectomy: Risk factors and associations with operative complications. Neurosurgery41:35-43, 1997.
16.
16. Hans SS, Glover JL: The relationship of cardiac and neurological complications to blood pressure changes following carotid endarterectomy. Am Surg61:356-359, 1995.
17.
17. Boganovic Z, Antic B, Tadic R, et al: Anatomic characteristics and clinical signs of congenital anomalies in the circle of Willis. Vojnosanitetski Pregled51:301-308, 1994.
18.
18. Hillen B: The variability of the circle of Willis: Univariate and bivariate analysis. Acta Morphol Neerl Scand24:87-101, 1986.
19.
19. Stephans RB, Steilwell DL: Internal carotid artery. In: Arteries and Veins of the Human Brain, ed. by Stephans RB, Steinwell DL. Springfield, IL: Charles C Thomas, 1969, pp 12-33.
