Chorea: Difference between revisions

Revision as of 16:57, 12 January 2021

Background

Movement disorder

Clinical Features

A case of Chorea-acanthocytosis: (A–C) Sequential snapshots from video demonstrating involuntary movements with closure of both eyes and lower-lip biting.Note: Lower-lip ulcer can be clearly seen in (A).

Involuntary worm-like movements

Differential Diagnosis

Causes of Chorea

Behavioral

Tourette
Behavioral or emotional disorders

Autoimmune or inflammatory

Sydenham's chorea (due to acute rheumatic fever)
Antiphospholipid syndrome
Autoimmune encephalitis
Behçet's disease
Celiac disease
Hashimoto encephalopathy
Polyarteritis nodosa
Primary angiitis of CNS
Sarcoidosis
Sjögren syndrome
Lupus

Cerebrovascular

Arteriovenous malformation (CNS)
Intracerebral hemorrhage
Ischemic stroke
Moyamoya disease
Postpump chorea (in children after cardiac surgery)
Subarachnoid hemorrhage
Polycythemia vera

Infectious

AIDS-related
Cruetzfeld-Jakob disease or other prion disease
Diphtheria
Legionnaire disease
Lyme disease
Malaria
Neurocysticercosis
Neurosyphilis
Progressive multifocal leukoencephalopathy
Toxoplasmosis
Tuberculosis

Metabolic/Endocrine

Derangements of calcium, glucose, sodium
- Hypocalcemia
Hypoparathyroidism
Oral contraceptives ^[1]
Chorea gravidarum (usually 1st trimester)^[2]
Nonketotic hyperglycemia ^[3]
Hyperthyroidism (rare)
Renal Failure

Drugs & Toxins

Alcohol intoxication or withdrawal
Carbon Monoxide
Illicit Drugs
- Cocaine
- Methamphetamines
- Glue sniffing
Dopamine Receptor Antagonists
- Metoclopramide (Reglan)
Cimetidine
Digoxin
Isoniazid
Verapamil
Theophylline

Paraneoplastic

Neoplasm with basal ganglia involvement
Small-cell lung cancer

Evaluation

Management

Treat the underlying disorder

Disposition

Consult Neurology if cause is unclear

References

↑ Miranda M, et al. Oral contraceptive induced chorea: another condition associated with anti-basal ganaglia antibodies. J Neurol Neurosurg Psychiatry 2004; 75(2): 327-328
↑ Bordelon YM, et al. Movement disorders in pregnancy. Semin Neurol 2007; 27(5):467-475
↑ Chang MH, et al. Non-ketotic hyperglycaemic chorea: a SPECT study. J Neurol neurosurg Psychiatry 1996; 60(4): 428-430

Authors:

[1] Miranda M, et al. Oral contraceptive induced chorea: another condition associated with anti-basal ganaglia antibodies. J Neurol Neurosurg Psychiatry 2004; 75(2): 327-328

[2] Bordelon YM, et al. Movement disorders in pregnancy. Semin Neurol 2007; 27(5):467-475

[3] Chang MH, et al. Non-ketotic hyperglycaemic chorea: a SPECT study. J Neurol neurosurg Psychiatry 1996; 60(4): 428-430

[1]

[2]

[3]

@@ Line 7: / Line 7: @@
 ==Differential Diagnosis==
-===Autoimmune===
+{{Chorea DDX}}
-*[[Sydenham's chorea]] (due to [[acute rheumatic fever]])
-*[[Lupus]]
-*Oral Contraceptives <ref> Miranda M, et al. Oral contraceptive induced chorea: another condition associated with anti-basal ganaglia antibodies. J Neurol Neurosurg Psychiatry 2004; 75(2): 327-328 </ref>
-*Chorea Gravidarum - usually in 1st trimester pregnancy <ref> Bordelon YM, et al. Movement disorders in pregnancy. Semin Neurol 2007; 27(5):467-475 </ref>
-===Vascular===
-*[[Stroke]]
-*Postpump chorea - in children after cardiac surgery
-*[[Polycythemia vera]]
-===Metabolic Disorders===
-*[[Hyperosmolar Hyperglycemic State (HHS)|Nonketotic hyperglycemia]] <ref> Chang MH, et al. Non-ketotic hyperglycaemic chorea: a SPECT study. J Neurol neurosurg Psychiatry 1996; 60(4): 428-430 </ref>
-*[[Hyperthyroidism]] (rare)
-*[[Renal Failure]]
-*[[Hypocalcemia]]
-===Drugs===
-*Illicit Drugs
-**[[Cocaine]]
-**[[Methamphetamines]]
-*Dopamine Receptor Antagonists
-**[[Metoclopramide]] (Reglan)
-*[[Cimetidine]]
-*[[Digoxin]]
-*[[INH|Isoniazid]]
-*[[Verapamil]]
-*[[Theophylline]]
-===[[Paraneoplastic]]===
-*Small-cell lung cancer
 ==Evaluation==