Generalized Chorea Secondary to a Right Putaminal Infarct: A Rare Manifestation of a Unilateral Basal Ganglia Lesion

Background: Chorea is typically characterized by irregular, involuntary movements resulting from basal ganglia dysfunction. While most basal ganglia lesions cause hemichorea contralateral to the lesion, generalized chorea due to a unilateral infarct is rare. Case Presentation: A 60-year-old hypertensive female presented with a three-day history of imbalance, transient loss of consciousness, and involuntary movements predominantly affecting the left upper and lower limbs, with milder involvement on the right. Examination revealed generalized chorea with left-side predominance and mild weakness (4+/5) in the left limbs. There were no other focal neurological deficits. MRI of the brain revealed a right subacute putaminal infarct. Other investigations including metabolic panel, ECG, echocardiography, and CT scan were unremarkable. Conclusion: This case highlights the rare occurrence of generalized chorea resulting from a unilateral putaminal infarct, underscoring the complex network-level role of basal ganglia in motor control.