Hemichorea as a Manifestation of Isolated Insular Infarction Successfully Treated with Mechanical Thrombectomy

Stroke-associated hyperkinetic movements are most often linked to basal ganglia lesions, while cortical or insular involvement is rarely reported. Hemichorea is an uncommon manifestation of acute ischemic stroke and may pose diagnostic and therapeutic challenges. We report the case of an 81-year-old woman presenting with acute Broca-type aphasia and left hemibody choreic movements. Initial computed tomography (CT)/computed tomography angiography revealed an occlusion of the right M2 segment of the middle cerebral artery. Perfusion imaging showed a significant ischemic penumbra without established infarction. Mechanical thrombectomy, performed eight hours after symptom onset, achieved complete reperfusion (Thrombolysis in Cerebral Infarction grade 3). Within 24 hours, aphasia resolved, and hemichorea markedly improved, persisting only as mild distal movements at discharge and completely disappearing within weeks. Magnetic resonance imaging demonstrated a small acute ischemic lesion confined to the right insular region. This case highlights the role of corticalsubcortical motor networks beyond the basal ganglia in the pathogenesis of post-stroke hyperkinetic movements. The insula, through its influence on temporalbasal ganglia pathways, may contribute to chorea generation. To our knowledge, this is the first reported case of hemichorea due to insular infarction successfully treated with thrombectomy, with complete clinical recovery.