Generalized chorea associated with chronic subdural hematomas
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Abstract Two patients with chronic bilateral subdural hematomas developed symmetrical generalized choreiform movements. In one patient the chorea disappeared after evacuation of the hematomas, and in the other the movements improved. The latter patient has a family history of Huntington's disease.Keywords:
Choreiform movement
Chronic Subdural Hematoma
Subdural Hematomas
Movement Disorders
We describe seven patients with genetically confirmed Huntington's disease (HD) who had non-choreic movement disorders as presenting symptoms or signs. Patients with movement disorders other than chorea in the early stages tended to have larger CAG trinucleotide repeat expansion in comparison with more "typical" HD patients.
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The acute onset of a unilateral choreiform movement dis order in a child with a recently documented febrile illness or streptococcal pharyngitis is suggestive of Sydenham chorea. The MR manifestations of two clinically corroborated cases of Sydenham chorea are summarized. Increased signal inten sity in the corpus striatum contralateral to the patients' symp tomatic side was observed on T2-weighted images. Focal enhancement in the involved head of the caudate was iden tified after IV administration of gadopentetate dimeglumine. The MR findings correlated with anatomic regions , which have been described to be susceptible to cross reaction with lgG antibodies that are formed in association with streptococcal infection.
Choreiform movement
Petit mal
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Choreiform movement
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Chorea is caused by a number of conditions, including genetic, metabolic derangements, infections, drugs, toxins, tumors, and disorders of the immune and inflammatory system of the body. Huntington's disease (HD) is the most common genetic cause of chorea. Systemic lupus erythematosus (SLE) is an autoimmune condition. Common symptoms include oral ulcers, joint pain, malar or discoid rashes, photosensitivity, and blood dyscrasias. It can involve the heart, lungs, kidneys, and brain. SLE can cause neuropsychiatric manifestations like psychosis, seizures, headache, confusion, and stroke. Chorea is a known symptom of SLE. HD is now recognized to involve more than one system and is associated with a number of comorbid conditions. We report the first case of hereditary choreiform disorder associated with and aggravated by SLE. This is also the first case report of probable Huntington disease from Balochistan, Pakistan. We report a 19-year-old girl with choreiform disorder and a family history of chorea. Choreiform disorder was present in her paternal grandmother and uncles. She presented with fever, cough, and aggravation of choreiform movements of upper and lower limbs for 10 days. She also complained of pain in the small joints of her hands and feet, oral ulcers, hair loss, and aggravation of choreiform movements for two and half months. Probable differential diagnoses of HD, Wilson's disease, and other types of hereditary chorea, aggravated by infections, SLE, or Covid-19, were made. Her initial lab results revealed pancytopenia, increased D-dimers and serum ferritin, positive antinuclear antibodies (ANA), and anti-double-stranded DNA (anti-dsDNA). Her C3 and C4 complement factors were low. The rest of the lab test results, including polymerase chain reaction (PCR) coronavirus disease (COVID-19), blood culture, and malaria, were negative. Thus, a diagnosis of hereditary chorea associated with and aggravated by SLE was made. Hereditary choreiform disorders can be associated with and aggravated by autoimmune conditions like SLE. Thus, it is recommended to be vigilant and have a low threshold for diagnosing co-existing autoimmune conditions like SLE in patients with hereditary choreiform disorder.
Choreiform movement
Cephalalgia
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The syndrome of chorea is usually classified under four main groups: (1) the infectious group, Sydenham's chorea and chorea gravidarum; (2) the psychogenic and hereditary group, comprising the spasmodic tics and Huntington's chorea; (3) the myokymia disorders, including symptomatic fibrillary twitchings and Friedreich's myoclonus multiplex, and (4) choreiform movements associated with organic conditions, occurring in hemiplegias, in the chronic choreas of childhood and in other structural brain disturbances, such as those associated with epidemic encephalitis. Many interesting clinical pictures have been reported, accompanying the recent epidemic of encephalitis. Bizarre muscular movements of almost every kind have been described. In a series of 154 cases, I have observed choreiform movements eight times. In one of these, a diagnosis of Sydenham's chorea was made during the first week, after which the patient became lethargic, complained of diplopia and presented the usual picture of epidemic encephalitis. Another patient, during the third week of
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Hyperkinesia
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Abstract Two patients with chronic bilateral subdural hematomas developed symmetrical generalized choreiform movements. In one patient the chorea disappeared after evacuation of the hematomas, and in the other the movements improved. The latter patient has a family history of Huntington's disease.
Choreiform movement
Chronic Subdural Hematoma
Subdural Hematomas
Movement Disorders
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Clinical features suggesting a diagnosis of Huntington's chorea in several siblings in a Black Rhodesian family are described. A progressive and eventually fatal mental deterioration accompanied by gradually worsening choreiform movements has until the present time occurred in only a single generation of this family, which precludes a definitive diagnosis based on the triad of family history, chorea and dementia. It is suggested that Huntington's chorea is the most likely diagnosis.
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Choreiform movement
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We report the case of 4-year-old male with sinus venous thrombosis leading to bilateral thalamic and basal ganglia strokes presenting as generalized choreiform movements. Acute-onset chorea in the pediatric population is most commonly associated with Sydenham chorea, which is a manifestation of acute rheumatic fever. Chorea is a much less commonly noted sign of stroke, and when it occurs, it typically presents as hemichorea. Given the unlikely presentation, rapid and appropriate imaging was the key to diagnosis.
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Stroke
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Choreiform movement
Tetrabenazine
Hyperkinesia
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Hyperkinesis
Animal model
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