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Ballism: causes, symptoms, diagnosis
Last reviewed: 05.07.2025
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Ballism is a rare type of hyperkinesis, manifested by large-scale, sharp, throwing (ballistic) movements, performed with great force, mainly by the proximal parts of the limbs. Hemiballism is observed more often, but there are cases of monoballism and paraballism (ballism on both halves of the body).
[ The main causes of ballism are:
I. Primary form - hereditary bilateral ballismus.
II. Secondary forms (usually hemiballismus):
- Strokes.
- Processes limiting the intracranial space.
- Traumatic brain injury.
- Infectious lesions of the nervous system.
- Intoxication.
- Metabolic disorders
- Inflammatory processes (angiitis).
- Neurosurgical interventions.
- Other rare causes.
The most common cause is cerebrovascular disease (ischemic infarction, intracerebral hemorrhage, transient ischemic attacks, subarachnoid hemorrhage, arteriovenous malformation) that damage the subthalamic nucleus of Lewis and its connections.
Hemiballismus has also been described with damage to the caudate nucleus, putamen, globus pallidus, precentral gyrus, or thalamic nuclei.
Most often, this syndrome develops with vascular accidents in the basin of the posterior thalamoperforating, posterior communicating or anterior choroidal arteries. There is a point of view that hemiballismus is a variant of hemichorea and is often described as the "hemichorea-hemiballismus" syndrome. The vascular cause of hemiballismus is rarely a cause of diagnostic difficulties. Characteristic clinical manifestations with an acute onset and a CT picture make the diagnosis reliable.
Space-limiting processes (primary glioma, metastatic tumor, cavernous hemangioma) are also known causes of hemiballismus. Clinical and paraclinical signs of increasing intracranial pressure, as well as neuroimaging data are decisive in the diagnosis of this form.
Infections such as toxoplasmosis, syphilis, tuberculosis, cryptococcosis and HIV infection have been described as causes of ballism.
Inflammatory processes associated with immune disorders can also lead to ballismus (systemic lupus erythematosus, scleroderma, antiphospholipid syndrome, immune reaction to herpes symplex, Sydenham's chorea). The appearance of ballismus in these diseases is often based on angiitis (systemic vasopathy).
Other possible causes: TBI, including childbirth, neurosurgical interventions (thalamotomy or thalamic stimulation; subthalamotomy or subthalamic stimulation; ventriculoperoneal shunt), metabolic disorders (hyperglycemia, hypoglycemia), drug intoxication (anticonvulsants, oral contraceptives, levodopa, ibuprofen), tuberous sclerosis, basal ganglia calcification, postictal state.
Bilateral ballismus is characteristic of primary (genetic) forms, but has also been described in vascular, toxic, demyelinating (multiple sclerosis) and degenerative diseases that occur with diffuse or multifocal lesions of subcortical formations.
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