Chorea

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Chorea
ICD-10 G25.5
ICD-9 333.5
DiseasesDB 16662
MeSH D002819

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Chorea sancti viti (Latin for "St. Vitus' dance") is an abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias. The term chorea is derived from a Greek word χορεία (a kind of dance), as the quick movements of the feet or hands are vaguely comparable to dancing or piano playing.

Presentation

Chorea is characterized by brief, irregular contractions that are not repetitive or rhythmic, but appear to flow from one muscle to the next.

These 'dance-like' movements of chorea (from the same root word as "choreography") often occur with athetosis, which adds twisting and writhing movements.

Causes

Chorea can occur in a variety of conditions and disorders.

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning

Carbon monoxide toxicity , Toulene poisoning

Dermatologic No underlying causes
Drug Side Effect

Amphetamines , Ethotoin , Lamotrigine , Levodopa , Dopamine agonists , Levomepromazine , Lithium , Methadone , Oral contraceptive pills , Phenothiazines , Phenytoin , Pramipexole, Tolcapone , Tricyclic antidepressants

Ear Nose Throat No underlying causes
Endocrine

Hypoglycaemia , Hypoparathyroidism, Thyrotoxicosis .

Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic

De Barsy syndrome , McLeod phenotype

Hematologic

Ceruloplasmin deficiency , Polycythemia , Porphyria , Henoch-Schönlein purpura

Iatrogenic No underlying causes
Infectious Disease

Rheumatic Fever , HIV

Musculoskeletal / Ortho No underlying causes
Neurologic

Huntington’s disease , Movement disorders , Ganglion , Wilson’s disease , Neuroacanthocytosis , Paroxysmal choreoathetosis , Cerebral birth injury , Kernicterus , cerebral trauma , Lacunar infarction , Creutzfeldt- Jacob disease , Cebral Palsy , Spinocerebellar ataxia 17 , Olivopontocerebellar atrophy 1, Idiopathic basal ganglia calcification , Hallervorden – Spatz disease , Troyer syndrome , Dentatorubropallidoluysian degeneration , Westphal disease , Neuhauser- Eichner –Opitz syndrome , Alternating hemiplegia of childhood , Spinocerebeller ataxia recessive 1 , Microcephaly-pontocerebellarhypoplasia-dyskinesia , Ataxia – telangiectasia , Cross- McKusick-Breen syndrome , Paroxysmal kinesigenic choreoathetosis , Neuroferritinopathy , Wolfram’s disease , Mount Reback syndrome , Paroxysmal nonkinesigenic choreathetosis , Gilles de la tourette syndrome , Fahr's syndrome , Familial benign chorea, Senile chorea , Haw river syndrome

Nutritional / Metabolic

Pyruvate decarboxylase deficiency , 3- Methylglutaconic aciduria type 3 , Benedikt’s syndrome , Infantile epileptic – dyskinetic encephalopathy , Ceroid lipofuscinosis , Glutaric aciduria type 1 , Lesch-Nyhan syndrome

Obstetric/Gynecologic

Pregnancy

Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte

Henosch - scholein purpura

Rheum / Immune / Allergy

SLE , Henosch - scholein purpura

Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous

Arterio-venous malformations

Causes In alphabetical order [1] [2]


Ballism

When chorea is serious, slight movements will become thrashing motions; this form of severe chorea is referred to as ballism. Walking may become peculiar, and include odd postures and leg movements. Unlike ataxia and dystonia, which affect the quality of voluntary movements or parkinsonism, which is a hindrance of voluntary movements, the movements of chorea and ballism occur on their own, without conscious effort.

Diagnosis

History and Symptoms

  • Complete history required
  • Psychiatric symptoms (Huntington's)

Appearance of the Patient

Eyes

Laboratory Findings

MRI and CT

Echocardiography or Ultrasound

  • In order to diagnose carditis, an ECG may be indicated

Other Imaging Findings

  • In order to reveal cerebral and cerebellar atrophies in patients with DRPLA, various imaging studies are indicated

Other Diagnostic Studies

Treatment

Cause Treatment
Huntington's disease A common treatment is dopaminergic antagonists, although treatment is largely supportive.
Sydenham's chorea Usually involves antibiotic drugs to treat the infection, followed by drug therapy to prevent recurrence.
Drug-induced chorea. Adjusting medication dosages.
Metabolic and endocrine-related choreas Treated according to the cause(s) of symptoms.

Acute Pharmacotherapies

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

See also


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