Ballism Associated with Partial Destruction of the Subthalamic Nucleus of Luys

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Abstract
Neurologic interest and curiosity concerning ballism seem out of proportion to the reported incidence of this uncommon form of dyskinesia. Cases of ballism with isolated lesions of the subthalamic nucleus, not associated with pre-existing lesions, are infrequent; only 14 such cases having been reported in the literature. Partial destruction of the corpus Luysi is rare and on the basis of clinical features cannot be detected from complete lesions. The case of a 73-year-old male hypertensive who sustained a previous cerebrovascular accident 6 years ago is given. Onset of left sided ballism followed cranial trauma and was associated with diminished proprioceptive and vibratory sense on the same side. A ventrolateral cordotomy at the level of the third cervical segment abolished the ballism without producing signs of pyramidal deficiency. Death occurred 23 days after onset of the ballism, due to bronchopneumonia. Section of the brain revealed an old cystic cavity in the left putamen and a recent vascular lesion in the right subthalamic nucleus. Marchi stained sections of brain revealed that the lesion destroyed approximately 31% of the right subthalamic nucleus. Marchi degeneration was present in the dorsal, middle and ventral divisions of the ansa lenticularis on the right side, and in the rostral portions of the substantia nigra. Review of the literature disclosed that ballism involved the left extremities twice as frequently as the right in 41 reported cases. The posterior cerebral artery and its branches appear to consistitute the primary vascular supply of the subthalamic nucleus. It was concluded: (1) that the limit of physiologic safety for the human subthalamic nucleus is of the same order as in the rhesus monkey despite its absolute size being 15 times larger (relative size is the same), (2) preexisting striatal lesion contralateral to the subthalamic lesion does not prevent appearance of ballism, (3) the possibility that localized lesions of the spinal cord may abolish ballistic activity is suggested by the current case and attempts to confirm this possibility seem worthwhile.