Video NeuroImage: Semiology and localization of ballistic movements Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy.

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Video NeuroImage: Semiology and localization of ballistic movements Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

Case Vignette 1 Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 1: Head CT Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 2 Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 2: brain MRI Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 3 Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 3 Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 4 Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Case Vignette 4: brain MRI Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Printed with permission, Mayfield Clinic Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology

Semiology and localization of ballistic movements Ballistic chorea (hemichorea-hemiballism) localizes to the subthalamic nucleus and its connections (Video 1, Figure A) or the putamen (Video 2, Figure B). Other large-amplitude hyperkinetic lesional movements can have similarly high localizing value. “Ballistic” tremor may develop months after recovering from ventrolateral thalamic strokes, in the thalamogeniculate vascular territory (Video 3, Figure C-D). 1 1 Similarly, “ballistic dystonia”, limb dystonia with superimposed arrhythmic and jerky movements often referred to as myoclonic dystonia, may develop months after recovering from combined vascular lesions in the striatum and posterior thalamus (Video 4, Figure E-F). 2 2 These motor complications, delayed by hours to days (hemiballism) or weeks to months (ballistic dystonia and tremor), have relatively distinct localization value to a narrow “ballistic corridor” in the basal ganglia and thalamus (Figure, lower panel). Gonzalez-Usigli and Espay, Neurology 2004 © 2014 American Academy of Neurology