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We're showing you and scrolling a patient

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with typical Huntington's Chorea,

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with atrophy in the lateral temporal region

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but sparing mostly the mesial temporal region,

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uncus and hippocampus, generalized atrophy,

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little involvement,

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but some mild atrophy of the cerebellum and

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frontoparietal atrophy,

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typical of this disorder with a genetic history.

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I want to talk briefly about vascular Choreas,

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vascular hemichorea,

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also known as hemiballism

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and ballism is an overlap syndrome

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with Huntington's Chorea,

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occurs in the region of the subthalamic nucleus,

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which is found down here below the frontal region.

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If I can pull up my FLAIR image,

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I think you can see it a little bit better.

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I like to go to the anterior commissure.

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Let's see if we can get there by going anteriorly.

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Here's the anterior commissure right there.

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And then I go to a cut right in front of it

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and this gray blob to which the inferior ventricle

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points is the subthalamic nucleus of Lewis.

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Typically,

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you'll have an ischemic or hemorrhagic lesion in

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the basal ganglia or in the subfrontal region

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underneath this point of the lateral ventricle,

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often corresponding to a lenticulostriate

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component of the middle cerebral or even

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perforators of the posterior cerebral artery.

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Spontaneous remission is the rule,

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but if the patient is at risk with dopamine

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depletors or other risk factors for Chorea,

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sometimes that vascular insult may then have

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a persistent manifestation of Chorea

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in that patient's life.

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An uncommon cause of Chorea is Moyamoya disease.

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This is an intracranial vasculopathy that presents

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with an ischemic lesion, or less commonly,

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with a hemorrhagic stroke of the basal ganglia.

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And another rare but important form of vascular

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Chorea is known as post-pump Chorea.

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This is a complication of extracorporeal

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circulation and the pathogenesis of

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this movement disorder thought to be

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associated with vascular insult of the basal

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ganglia during the actual surgical procedure.

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If you have time,

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let's move on to a discussion of

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Chorea in neoplastic syndromes.