View source for Chorea

==Background==
*Chorea = involuntary, irregular, purposeless, non-rhythmic movements that flow from one body part to another
*Distinct from tremor (rhythmic) and dystonia (sustained)
*Key EM role: identify '''treatable and emergent causes''' — particularly Sydenham's chorea, drug-related, and hyperglycemia-induced
{{Chorea DDX}}

==Clinical Features==
[[File:PMC4772938 imcrj-9-039Fig1.png|thumb|Chorea-acanthocytosis: involuntary movements with eye closure and lip biting.]]
*Involuntary, dance-like, flowing movements
*May appear as motor restlessness or clumsiness
*Milkmaid's grip (inability to maintain sustained grip)
*Motor impersistence (tongue darting)
*Ballismus = large-amplitude, violent, flinging chorea (usually hemiballismus from subthalamic nucleus stroke)

==Differential Diagnosis==
{{Movement disorder DDX}}

===Emergent/Treatable===
*'''Hemiballismus/hemichorea''': stroke (subthalamic nucleus) or non-ketotic hyperglycemia
*'''Sydenham's chorea''': post-streptococcal (rheumatic fever) — may appear months after infection
*'''Drug-induced''': [[levodopa]], [[phenytoin]], [[carbamazepine]], stimulants, oral contraceptives
*'''Wilson's disease''': young patient + liver disease + Kayser-Fleischer rings
*'''Anti-NMDA receptor encephalitis''': young women, psychiatric symptoms + chorea + seizures
*'''[[Thyrotoxicosis]]'''

===Chronic/Hereditary===
*Huntington's disease (progressive dementia + chorea, family history)

==Evaluation==
*Medication review (common cause of new chorea)
*Bedside glucose (non-ketotic hyperglycemia is reversible)
*[[BMP]], [[CBC]], [[TSH]]
*CT/MRI brain if hemiballismus or focal deficit (stroke)
*ASO titer if Sydenham's suspected (pediatric)
*Ceruloplasmin if Wilson's suspected

==Management==
*Treat underlying cause (stop offending drug, correct hyperglycemia)
*Hemiballismus: [[haloperidol]] or [[valproic acid]] for severe movements
*Neurology consultation for unclear or new-onset chorea

==Disposition==
*Admit: stroke-related, non-ketotic hyperglycemia with neuro symptoms, anti-NMDA receptor encephalitis
*Discharge: known chorea at baseline or mild drug-induced — with neurology follow-up

==See Also==
*[[Tremor]]

==References==
<references/>

[[Category:Neurology]]