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Hemiballism and dysarthria due to and relief of parkinsonism by subthalamic nucleus stimulation in Parkinson disease

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Hemiballism and dysarthria due to and relief of parkinsonism by subthalamic nucleus stimulation in Parkinson disease

This man with advanced Parkinson disease has characteristic extrapyramidal signs during the true “off” state (at least 12 hours after last dose of levodopa). The signs include a coarse tremor, which involves the left lower extremity preponderantly--an unusual finding, rigidity, bradykinesia, masked face, hypophonia, and loss of associated movements. With deep brain stimulation (DBS) of the right subthalamic nucleus (STN), he gets relief of the left lower limb tremor and some other extrapyramidal signs but develops left-sided hemiballism, worse in the upper limb, and worse dysarthria. (Contributed by Dr. Joseph Jankovic.)

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