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•- The authors have no financial conflicts of interest. Copyright © 2013 The Korean Movement Disorder Society 17 Involuntary movement associated with deep watershed ischemic lesions has been rarely re-ported. A 67-year-old woman presented with acute hemichorea on the left side. Magnetic resonance imaging showed acute infarcts in the anterior border zone. On perfusion studies, impaired cerebral blood flow was observed on the subcortical region sparing the basal gan-glia. Cerebral angiogram confirmed severe stenosis in the right internal carotid artery. Her hemichorea gradually improved along with normalization of perfusion after carotid artery stenting with angioplasty. We suggest that impaired cerebral blood flow in critical watershed territories may be an important contributing factor in hemichorea associated with carotid oc-clusive disease. Journal of Movement Disorders 2013;6:17-20 Key Words: Hemichorea, Carotid stenosis, Stents, Perfusion weighted MRI. Hemichorea refers to forcible, flowing, involuntary arrhythmic movements on one side of the body. It may be associated with various conditions, such as cerebrovascular diseases, drugs, metabolic abnormalities, neurodegenerative diseases, and immunologic disorders.1 Chorea has been reported as the most common post-stroke movement disorder, usually as-sociated with a lesion in the contralateral basal ganglia or related structures.2 Involuntary movement associated with deep watershed ischemic lesions that spare the basal ganglia has been rarely reported. We describe a patient with acute hemichorea associated with hemody-namic ischemia due to severe carotid artery stenosis, with reports of perfusion studies and discussion on its pathogenic mechanism