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Ballistics: Causes, Symptoms, Diagnosis
Last reviewed: 23.04.2024
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Ballism is a rare variety of hyperkinesia, manifested by large-scale, sharp, throwing (ballistic) movements, performed with great strength mainly by proximal parts of the extremities. Gemiballism is more common, but there are cases of monoballism and paraballism (ballistics on both halves of the body).
[The main causes of ballistics:
I. Primary form - hereditary bilateral ballistics.
II. Secondary forms (usually hemiballism):
- Strokes.
- Processes that limit intracranial space.
- Craniocerebral injury.
- Infectious lesions of the nervous system.
- Intoxication.
- Metabolic disorders
- Inflammatory processes (angiitis).
- Neurosurgical interventions.
- Other rare causes.
The most common cause is cerebrovascular diseases (ischemic infarction, intracerebral haemorrhage, transient ischemic attacks, subarachnoid hemorrhage, arteriovenous malformation), damaging the subthalamic Lewis core and its connections.
Hemiballism is also described in injuries of the caudate nucleus, the shell, the pale sphere, the precentral gyrus or thalamic nuclei.
Most often this syndrome develops in vascular accidents in the basin of the posterior thalamoperforating, posterior connective or anterior choreoid arteries. There is a point of view that hemiballism is a variant of hemichorei and is often described as a syndrome of "hemichorei-hemiballism". The vascular cause of hemiballism is rarely the cause of diagnostic difficulties. Characteristic clinical manifestations with acute onset and CT scan make the diagnosis reliable.
The processes that limit space (primary glioma, metastatic tumor, cavernous hemangioma) also relate to the known causes of hemiballism. Clinical and paraclinical signs of increasing intracranial pressure, as well as neuroimaging data, are crucial in the diagnosis of this form.
Such infections as toxoplasmosis, syphilis, tuberculosis, cryptococcosis and HIV infection are described among the causes of ballistics.
Inflammatory processes associated with immune disorders are also capable of leading to ballistics (systemic lupus erythematosus, scleroderma, antiphospholipid syndrome, immune response to herpes symplex, Sydenham's chorea). At the root of the appearance of ballistic disease in these diseases often lies angiitis (systemic vasopathy).
Other possible causes: traumatic brain injury, including birth, 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 condition.
Bilateral ballistics is characteristic of primary (genetic) forms, but is also described for vascular, toxic, demyelinating (multiple sclerosis) and degenerative diseases that occur with diffuse or multifocal lesions of subcortical formations.
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