Stroke Triggers Delayed Movement Disorder Weeks After Carotid Surgery
A 79-year-old man developed involuntary movements weeks after carotid surgery, revealing a rare stroke complication.
Summary
This case report from Rome describes an unusual neurological complication in a 79-year-old man who underwent carotid endarterectomy — a common surgery to clear a blocked carotid artery — to reduce stroke risk. Weeks after the procedure, he developed hemichorea-dystonia, a movement disorder characterized by involuntary, jerking, and twisting movements on one side of the body. Imaging revealed a cortical temporal stroke as the underlying cause. What makes this case notable is the delayed onset of the movement disorder, which can make diagnosis challenging. Clinicians may not immediately connect new involuntary movements to a prior stroke or vascular procedure. The case highlights that movement disorders can emerge as late complications of cerebrovascular events, and that cortical strokes — not just deep brain lesions — can trigger these symptoms.
Detailed Summary
Movement disorders following stroke are well-recognized but often associated with damage to deep brain structures like the basal ganglia. This case report challenges that assumption by documenting a cortical stroke as the trigger for a delayed movement disorder, underscoring the need for broader diagnostic thinking in post-stroke neurology.
Researchers at Università Cattolica del Sacro Cuore in Rome describe a 79-year-old man who underwent right carotid endarterectomy — a surgical procedure to remove plaque from the internal carotid artery and reduce stroke risk. The surgery itself is a standard intervention for significant carotid stenosis, but in this patient, it was followed by an unexpected neurological complication.
Weeks after the procedure, the patient developed hemichorea-dystonia affecting one side of his body. This movement disorder involves a combination of chorea — rapid, involuntary, dance-like movements — and dystonia, which causes sustained muscle contractions and abnormal postures. Neuroimaging identified a cortical temporal stroke as the causative lesion, an atypical location for this type of movement disorder.
The delayed presentation is clinically significant. When movement disorders emerge days to weeks after a vascular event or surgery, the connection to the original cause may not be immediately apparent. This can lead to diagnostic delays, unnecessary workups, or misattribution to other conditions such as medication side effects or a new neurological disease.
This case serves as an important reminder for clinicians managing post-surgical or post-stroke patients: involuntary movements appearing in the weeks following a cerebrovascular event should prompt consideration of delayed stroke-related movement disorders, even when the lesion is cortical rather than subcortical. Awareness of this presentation may accelerate diagnosis and guide appropriate management in an aging population increasingly undergoing vascular interventions.
Key Findings
- Cortical temporal stroke — not just deep brain lesions — can cause hemichorea-dystonia.
- Movement disorder onset was delayed after carotid endarterectomy, complicating diagnosis.
- Case involves a 79-year-old, highlighting vascular surgery risks in elderly patients.
- Delayed post-stroke movement disorders may be misdiagnosed without vascular history review.
Methodology
This is a single case report published in JAMA Neurology, describing one patient's clinical course following carotid endarterectomy. The report is based on clinical observation, neuroimaging, and neurological examination findings. No control group or comparative data are included.
Study Limitations
This is a single case report, limiting generalizability to broader patient populations. The summary is based on the abstract only, as the full text is not open access, so detailed imaging findings, timeline, and treatment response are unavailable. No causal mechanism between the cortical lesion and movement disorder is described in the available text.
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