OBJECTIVE: To study clinical associations of hyperkinesia ipsilateral (IH) to the lesion in acute stroke.
BACKGROUND: Hyperkinesia ipsilateral to the lesion (IH), i.e. contralateral to sensorimotor deficits, is poorly studied. IH is a syndrome defined by a stereotypic hyperactivity, such as compulsive manipulation of objects in the bed, repetitive body manipulation or apparent purposeless exercising of the preserved hemibody, contralateral to the deficit, that lasts only a few days after acute strokes. IH may be related to acute plastic changes in sensorimotor maps after stroke.
DESIGN/METHODS: We prospectively studied 100 consecutive patients in their acute phase of stroke for IH. We verified the association of IH with the topography of strokes (cortical pre-and/or post-central, corona radiata, basal ganglia, internal capsule, thalamus, brainstem), age, gender, ischemic or hemorrhagic etiology and presence of sensory deficits or ataxia using chisquare tests and logistic regression analysis.
RESULTS: IH showed significant associations with cortical stroke (p=0.022), either precentral (p=0.009) or postcentral (p=0.005), as well as with lesions of the corona radiata (p=0.008), internal capsule (p=0.046), but surprisingly not of the basal ganglia or brainstem. Logistic regression analysis showed no significant topographic prediction of IH. Neither the ischemic or hemorrhagic nature of lesion, side, age, changes in tone or reflexes nor ataxia were associated with the presence of IH, whereas being a woman (p=0.034), the presence of contralateral sensory deficits (p=0.0001) or contralateral autonomic dysfunction (p=0.004) were significantly associated with IH. Major presentations of this syndrome were associated with large lesions.
CONCLUSIONS: IH is associated with cortical strokes, contralateral sensory deficits and dysautonomia, but not with strokes in basal ganglia, probably sharing similar sensory mechanisms with hyperkinesia due to loss of proprioception such as seen in pseudoathetosis, sensory alien hand or hyperconcern, rather than hyperkinesis due to basal ganglia lesions. IH may also be the clinical expression of plastic changes in sensorimotor cortical maps after acute stroke. The predominance of women in this presentation may signify differences in body awareness or representation between men and women.