Chorea
Background
- Movement disorder
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
- 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
Clinical Features
- Involuntary worm-like movements
Differential Diagnosis
Movement Disorders and Other Abnormal Contractions
- Chorea
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Hypocalcemia
- Strychnine toxicity
- Acute tetanus
- Parkinson's disease
- Mono amine oxidase inhibitor toxicity
- Phencyclidine toxicity
- Anti-NMDA receptor encephalitis
- Huntington disease
- Wilson's disease
- CVA
- Schizophrenia
- Psychotic agitation
- Dementia
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
- Dystonic reaction
- Extrapyramidal reaction
- Torticollis
- Idiopathic movement disorder
Evaluation
Management
Treat the underlying disorder
Disposition
- Consult Neurology if cause is unclear
See Also
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