Spontaneous triple flexion after thalamo-capsular haemorrhagic stroke.

A 52-year-old woman presented to the emergency room with a right thalamo-capsular haemorrhage exhibiting involuntary, stereotyped movements in her left lower limb. These movements started at the same time as ictal deficits and consisted of hip and knee flexion, foot dorsiflexion and extension of the hallux, resembling a triple flexion response. They occurred spontaneously, but could also be elicited by stimulating pathological reflexes. Such semiological finding could first be interpreted as a hyperkinetic manifestation resulting from a lesion in the basal ganglia; however, these movements do not correspond to any of those classically described syndromes. Alternatively, we hypothesise that they resulted from a loss of central inhibition of spinal motor reflexes secondary to a lesion extending into the corticospinal tract and thalamus. To our knowledge, no cases of spontaneous triple flexion response have been described following stroke. This article highlights that triple flexion response may occur spontaneously and should not be mistaken for volitional movements.