Objective:

To identify the incidence of and characterize movement disorders that arise within one year after acute ischemic stroke (AIS) treated with IV thrombolytic therapy (IVT), mechanical thrombectomy (MT), or both.

Background:

Movement disorders emerging after ischemic stroke have been previously described and emerged with low frequencies. However, new patterns of brain infarction have emerged in the wake of MT as a standard of care for ischemic stroke with large vessel occlusion, including infarcts selectively or primarily involving the basal ganglia.

Design/Methods:

This was a retrospective cohort study of 362 patients diagnosed with AIS treated with IVT, MT, or both from January 2016 to December 2022 at a Comprehensive Stroke Center with at least one outpatient Neurology followup within one year of stroke onset. Neuroimages were directly reviewed to identify patients with basal ganglia (BG) infarcts, extensive MCA cortical infarcts (>1/3 of MCA territory), and primary motor cortex infarcts. Discharge summaries and outpatient Neurology notes were reviewed during the specified time frame to determine the presence or absence of new movement disorders and the specific characterization. 

Results:

Of the 362 patients in our overall sample, 24 patients (6.6%) were documented to have delayed onset movement disorders (71% hemiparkinsonism, 25% tremor, 4% dystonia) following AIS. 15.7% of patients with acute BG infarcts developed movement disorders, compared with 1.3% in patients without BG infarcts (p<0.001). Of the 100 patients with acute BG infarcts without extensive MCA cortical infarcts and without primary motor cortex infarcts, 18% developed movement disorders. 

Conclusions:

Patients with AIS treated with IVT, MT, or both have higher than previously appreciated incidence of developing movement disorders in the following year, especially patients with BG involvement or selective BG infarcts. Optimal strategies for detection and management of delayed onset post-stroke movement disorders should be studied.