Acute mania and hemichorea

A 61-year-old man suddenly became euphoric and talkative. Later the same da y, he developed hemichoreic movements of the left limbs. The patient fulfil led the DSM-IV criteria for a manic episode by abnormally and persistently elevated mood, decreased need for sleep, high distractibility, pressured sp eech, increased goal-directed activity, and hypersexuality. The mood change s persisted for several weeks. Magnetic resonance imaging of the brain show ed a right thalamic infarction. The co-occurrence of hemichorea and mania c aused by focal thalamic lesion is very rare. It may be explained by dysfunc tion in basal ganglia thalamocortical circuitry.