A case-report from Baroda Medical College, India, concerns a 9-year-old girl who complained of difficulty in walking and involuntary movements of the left upper and lower limbs. On neurological examination she had chorea involving the left side, bilateral lateral rectus palsy, and spasticity of the right upper and lower limbs. CT scan and MRI showed a focal glioma involving the upper pons and midbrain. Following surgery for removal of the tumor, hemi-chorea decreased in intensity. Histopathological examination showed a pilocystic astrocytoma grade 1. [1]

COMMENT. Brain tumor is an unusual cause of extrapyramidal signs and symptoms. In children treated at the Mayo Clinic between 1950 and 1960, 4% of brain tumors involved the basal ganglia but <1% were associated with involuntary movements. In a report of 2 children, ages 6 and 12 years, presenting with choreiform movements and dystonia, the tumor involved the right thalamus in one and was caudad to the thalamus, in the mesencephalon and upper pons, in the other [2]. The localization of the lesion involved with involuntary movements often shows discrepancies, and only lesions in the subthalamic nucleus of Luys are attended by a consistent clinical disorder, usually a contralateral hemichorea or hemiballism [3]. Tumor as a cause of choreiform disorder should be considered when the involuntary movements are progressive and are associated with cranial nerve lesions and crossed hemiparesis and/or ataxia. [4]