Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Helicobacter Pylori Hemiballismus 669

■80% of untreated peptic ulcer patients infected withH. pyloriwill

relapse

■20% of peptic ulcer patients treated for and cured ofH. pyloriwill

still relapse

Hemiballismus......................................

CHAD CHRISTINE, MD

history & physical

■Unilateral chorea of acute to subacute onset

■Continuous movement that pt may attempt to restrain

■Proximal muscle involvement causes particularly violent movements

■May involve face, arm, leg or both extremities on one side of body

■Cognitive, motor, sensory deficits may be present

tests

■Diagnosis made clinically

■Lab tests: CBC, sed rate, HIV test, toxicology screen

■Imaging may demonstrate lesion of contralateral subthalamic

nucleus

differential diagnosis

■Stroke & mass lesion (eg, tumor, abscess, AVM) excluded by brain

MRI

■Inflammatory disorders (SLE, antiphospholipid antibody syndrome)

& metabolic disorders (hyper-/hypoglycemia) excluded by serum

studies

■Infections excluded by blood & CSF studies

management

■What to do first: evaluate for stroke or mass lesion

■General measures: comfortable setting, restrain limb, pad bedside

specific therapy

■Depends on underlying disorder

■Indications: intractable violent movements

■Treatment options

➣Medical treatment

Haloperidol

Chlorpromazine

➣Surgical treatment