Pseudoathetosis: Three cases of delayed-onset movement disorder

Abstract

Pseudoathetosis refers to choreoathetoid movements occurring in association with loss of proprioception. The responsible lesions can be located most anywhere and indicates a disruption of the proprioceptive pathway, from peripheral nerves to the parietal cortex. We describe the clinical courses, radiologic findings and treatments of 3 patients with spinal pseudoathetosis. Patients 1 and 3 experienced the movement disorder 2 years and 6 months, respectively, after resections of spinocerebellar tumors. Patient 2 had bilateral arm weakness from cervical disc herniation one year prior to the onset of pseudoathetosis. MRI of the cervical spine revealed lesions in the dorsolateral column of the cervical cord as the cause of the impaired proprioceptive sensation. Since the clinical course of two patients had shown delayed onset following a neuro-surgical procedure, the consequent neuroplasticity of disruptive sensory pathways was thought to be the explanation for the development of the pseudoathetosis. Pseudoathetosis in the second case could be due to a natural course of progression from cervical cord compression. In conclusion, pseudoathetosis is a rare movement disorder and the pathophysiology remains an enigma.