Diferencia entre revisiones de «Chorea»
(Expanded with concise EM-focused content: treatable causes, hemiballismus, hyperglycemia-induced, evaluation, disposition)
 
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==Background==
==Background==
*Movement disorder
*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==
==Clinical Features==
[[File:PMC4772938 imcrj-9-039Fig1.png|thumb|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).]]
[[File:PMC4772938 imcrj-9-039Fig1.png|thumb|Chorea-acanthocytosis: involuntary movements with eye closure and lip biting.]]
*Involuntary worm-like movements
*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==
==Differential Diagnosis==
===Autoimmune===
{{Movement disorder DDX}}
*Sydenham's Chorea - due to [[acute Rheumatic Fever]]
 
*[[Lupus]]
===Emergent/Treatable===
*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>
*'''Hemiballismus/hemichorea''': stroke (subthalamic nucleus) or non-ketotic hyperglycemia
*Chorea Gravidarum - usually in 1st trimester pregnancy <ref> Bordelon YM, et al. Movement disorders in pregnancy. Semin Neurol 2007; 27(5):467-475 </ref>
*'''Sydenham's chorea''': post-streptococcal (rheumatic fever) — may appear months after infection
===Vascular===
*'''Drug-induced''': [[levodopa]], [[phenytoin]], [[carbamazepine]], stimulants, oral contraceptives
*[[Stroke]]
*'''Wilson's disease''': young patient + liver disease + Kayser-Fleischer rings
*Postpump chorea - in children after cardiac surgery
*'''Anti-NMDA receptor encephalitis''': young women, psychiatric symptoms + chorea + seizures
*[[Polycythemia vera]]
*'''[[Thyrotoxicosis]]'''
===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>
===Chronic/Hereditary===
*[[Hyperthyroidism]] (rare)
*Huntington's disease (progressive dementia + chorea, family history)
*[[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==
==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==
==Management==
''Treat the underlying disorder''
*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==
==Disposition==
*Consult Neurology if cause is unclear
*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==
==See Also==
*[[Tremor]]


==References==
==References==

Revisión actual - 00:41 21 mar 2026

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

Causes of Chorea

Behavioral

  • Tourette
  • Behavioral or emotional disorders

Autoimmune or inflammatory

Cerebrovascular

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

Drugs & Toxins

Paraneoplastic

  • Neoplasm with basal ganglia involvement
  • Small-cell lung cancer

Clinical Features

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 Disorders and Other Abnormal Contractions

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

References

  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
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