An 82-year-old man with flailing movements of his right side after a stroke

CASE PRESENTATION An 82-year-old man with a history of hypertension, renal insufficiency, and polycystic kidney disease was admitted to hospital for acute onset of right hemiparesis and right facial paresis. His vital signs were significant for a blood pressure of 244/110. Head computed tomography (CT) demonstrated a hemorrhagic stroke involving the left thalamus and left cerebral peduncle. His blood pressure was lowered; he was monitored and treated with supportive care for several days before being discharged to a rehabilitation center. The hemiparesis improved slowly. Approximately 1 month later he began having involuntary flailing movements of the right arm and leg, which worsened with effort and decreased at rest. They did not occur while asleep. Successive trials of clonazepam, gabapentin, and haloperidol (maximum dose: 12 mg per day) were unsuccessful. The movements significantly impaired his functioning, making all activities of daily living difficult.