Chorea: Difference between revisions

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== Causes ==
== Causes ==
Chorea can occur in a variety of conditions and disorders.  
Chorea can occur in a variety of conditions and disorders.  
* Chorea is a primary feature of [[Huntington's disease]], a progressive, hereditary movement disorder.  
* Chorea is a primary feature of [[Huntington's disease]], a progressive, hereditary movement disorder.  
* Twenty percent of children and adolescents with [[rheumatic fever]] develop [[Sydenham's chorea]] as a complication.  
* Twenty percent of children and adolescents with [[rheumatic fever]] develop [[Sydenham's chorea]] as a complication.  
* [[Chorea]] may also be caused by drugs ([[levodopa]], [[anti-convulsant]]s, [[anti-psychotic]]s), metabolic disorders, endocrine disorders, and vascular incidents.
* [[Chorea]] may also be caused by drugs ([[levodopa]], [[anti-convulsant]]s, [[anti-psychotic]]s), metabolic disorders, endocrine disorders, and vascular incidents.
 
===Common Causes===
 
 
===Causes by Organ System===
===Causes by Organ System===
* To obtain the coding for the table seen below, click [[Differential diagnosis by organ system table|here]]. You need to copy the table content from the edit box, and paste it into the edit box.
* You can then list the causes by organ system. List the causes, separated by a comma under the appropriate category where it says "No underlying causes". Erase "No underlying causes" if you are listing causes in that category.
* For an example of the causes by organ system table in a causes microchapter, click [[Jaundice causes#Causes by Organ System|here]].
{|style="width:75%; height:100px" border="1"
{|style="width:75%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"|
|bgcolor="Beige"|
[[Carbon  monoxide toxicity ]]
[[Carbon  monoxide toxicity ]], [[Toulene poisoning ]]
 
[[Toulene poisioning ]]


|-
|-
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| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|  
|bgcolor="Beige"|  
 
[[Amphetamines  ]], [[Ethotoin ]], [[Lamotrigine ]], [[Levodopa ]], [[Dopamine agonists  ]], [[Levomepromazine ]], [[Lithium  ]], [[Methadone ]], [[Oral contraceptive pills ]], [[Phenothiazines ]], [[Phenytoin ]], [[Pramipexole]], [[Tolcapone ]], [[Tricyclic antidepressants ]]
[[Amphetamines  ]]
 
[[Ethotoin ]]
 
[[Lamotrigine ]]
 
[[Levodopa, Dopamine agonists  ]]
 
[[Levomepromazine ]]
 
[[Lithium  ]]
 
[[Methadone ]]
 
[[Oral contraceptive pills ]]
 
[[Phenothiazines ]]
 
[[Phenytoin ]]
 
[[Tolcapone ]]
 
[[Tricyclic antidepressants ]]


|-
|-
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| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|  
|bgcolor="Beige"|  
[[Hypoglycaemia  ]]
[[Hypoglycaemia  ]], [[Hypoparathyroidism]], [[Thyrotoxicosis ]].
 
[[Hypoparathyroidism.]]
 
[[Thyrotoxicosis ]]


|-
|-
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| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"|  
|bgcolor="Beige"|  
[[De  Barsy syndrome ]]
[[De  Barsy syndrome ]], [[McLeod phenotype  ]]
 
[[McLeod phenotype  ]]


|-
|-
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| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|  
|bgcolor="Beige"|  
[[Ceruloplasmin  deficiency ]]
[[Ceruloplasmin  deficiency ]], [[Polycythemia ]], [[Porphyria ]], [[Henoch-Schönlein purpura]]
 
[[Polycythemia ]]
 
[[Porphyria ]]
[[Henosch  - scholein purpura]]


|-
|-
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|bgcolor="Beige"|  
|bgcolor="Beige"|  


[[Rheumatic  Fever ]]
[[Rheumatic  Fever ]], [[HIV ]]
 
[[HIV ]]


|-
|-
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|bgcolor="Beige"|  
|bgcolor="Beige"|  


[[Huntington’s  disease ]]
[[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  ]]  
 
[[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]]


|-
|-
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|bgcolor="Beige"|  
|bgcolor="Beige"|  


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


|-
|-
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|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| No underlying causes
|-
|-
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| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|  
|bgcolor="Beige"|  
[[SLE ]]
[[SLE ]], [[Henosch - scholein purpura]]
 
[[Henosch - scholein purpura]]


|-
|-
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[[Arterio-venous  malformations ]]
[[Arterio-venous  malformations ]]


[[Senile chorea ]]
|-
|}


[[Haw river syndrome  ]]
=== Causes In alphabetical order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===


|-
{{MultiCol}}
|}
* [[3- Methylglutaconic aciduria  type 3 ]]
* [[Alternating hemiplegia of  childhood ]]
* [[Amphetamines  ]]
* [[Arteriovenous malformations  ]]
* [[Ataxia – telangiectasia ]]
* [[Benedikt’s syndrome ]]
* [[Carbon monoxide toxicity ]]
* [[Cebral Palsy ]]
* [[Cerebral birth injury ]]
* [[cerebral trauma ]]
* [[Ceroid lipofuscinosis ]]
* [[Ceruloplasmin deficiency ]]
* [[Creutzfeldt- Jacob disease  ]]
* [[Cross- McKusick-Breen  syndrome ]]
* [[De Barsy syndrome ]]
* [[Dentatorubropallidoluysian  degeneration ]]
* [[Dopamine agonists  ]]
* [[Ethotoin ]]
* [[Fahr’s disease ]]
* [[Familial benign chorea]]
* [[Ganglion ]]
* [[Gilles de la tourette  syndrome ]]
* [[Glutaric aciduria type 1 ]]
* [[Hallervorden – Spatz disease  ]]
* [[Haw river syndrome  ]]
* [[Henoch-Schönlein purpura]]
* [[HIV ]]
* [[Huntington’s disease ]]
* [[Hypoglycaemia ]]
* [[Hypoparathyroidism]]
* [[Idiopathic basal ganglia  calcification ]]
* [[Infantile epileptic –  dyskinetic encephalopathy ]]
* [[Kernicterus ]]
* [[Lacunar infarction ]]
* [[Lamotrigine ]]
* [[Lesch-Nyhan syndrome ]]
* [[Levodopa ]]
* [[Levomepromazine ]]
* [[Lithium  ]]
* [[McLeod phenotype  ]]
{{ColBreak}}
* [[Methadone ]]
* [[Microcephaly-pontocerebellarhypoplasia-dyskinesia  ]]
* [[Mount Reback syndrome ]]
* [[Movement disorders ]]
* [[Neuhauser- Eichner –Opitz  syndrome ]]
* [[Neuroacanthocytosis ]]
* [[Neuroferritinopathy ]]
* [[Olivopontocerebellar atrophy  1 ]]
* [[Oral contraceptive pills ]]
* [[Paroxysmal choreoathetosis  ]]
* [[Paroxysmal kinesigenic  choreoathetosis ]]
* [[Paroxysmal nonkinesigenic  choreathetosis ]]
* [[Phenothiazines ]]
* [[Phenytoin ]]
* [[Polycythemia ]]
* [[Porphyria ]]
* [[Pregnancy]]
* [[Pyruvate decarboxylase  deficiency ]]
* [[Respiratory failure ]]
* [[Rheumatic Fever ]]
* [[Senile chorea ]]
* [[SLE ]]
* [[Spinocerebellar ataxia 17 ]]
* [[Spinocerebeller ataxia  recessive 1 ]]
* [[Thyrotoxicosis ]]
* [[Tolcapone ]]
* [[Toulene poisioning ]]
* [[Tricyclic antidepressants ]]
* [[Troyer syndrome ]]
* [[Westphal disease ]]
* [[Wilson’s disease ]]
* [[Wolfram’s disease ]]
{{EndMultiCol}}


== Ballism ==
== 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.
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.
== Causes In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>==
[[Amphetamines  ]]
[[Carbon monoxide toxicity ]]
[[Ceruloplasmin deficiency ]]
[[De Barsy syndrome ]]
[[Ethotoin ]]
[[Hypoglycaemia ]]
[[Hypoparathyroidism.]]
[[Lamotrigine ]]
[[Levodopa, Dopamine agonists  ]]
[[Levomepromazine ]]
[[Lithium  ]]
[[McLeod phenotype  ]]
[[Methadone ]]
[[Oral contraceptive pills ]]
[[Phenothiazines ]]
[[Phenytoin ]]
[[Polycythemia ]]
[[Porphyria ]]
[[Thyrotoxicosis ]]
[[Tolcapone ]]
[[Toulene poisioning ]]
[[Tricyclic antidepressants ]]
[[Rheumatic Fever ]]
[[HIV ]]
[[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]]
[[Pyruvate decarboxylase  deficiency ]]
[[3- Methylglutaconic aciduria  type 3 ]]
[[Benedikt’s syndrome ]]
[[3- methyglutaconic aciduria  type 3 ]]
[[Infantile epileptic –  dyskinetic encephalopathy ]]
[[Ceroid lipofuscinosis ]]
[[Glutaric aciduria type 1 ]]
[[Lesch-Nyhan syndrome ]]
[[Pregnancy]]
[[Respiratory failure ]]
[[SLE ]]
[[Henosch - scholein purpura]]
[[Arterio-venous malformations  ]]
[[Senile chorea ]]
[[Haw river syndrome  ]]


== Diagnosis ==  
== Diagnosis ==  
== History and Symptoms ==  
=== History and Symptoms ===  
* Complete history required
* Complete history required
* Psychiatric symptoms (Huntington's)
* Psychiatric symptoms (Huntington's)


== Appearance of the Patient ==
=== Appearance of the Patient ===
=== Eyes ===
=== Eyes ===
* Appearance of [[Kayser-Fleischer ring]]s in [[cornea]] is diagnostic for [[Wilson's disease]] (slit-lamp examination)
* Appearance of [[Kayser-Fleischer ring]]s in [[cornea]] is diagnostic for [[Wilson's disease]] (slit-lamp examination)


== Laboratory Findings ==  
=== Laboratory Findings ===  


* [[Antinuclear antibody]] ([[ANA]]) to diagnose [[lupus]]
* [[Antinuclear antibody]] ([[ANA]]) to diagnose [[lupus]]
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|}
|}


== Acute Pharmacotherapies ==  
=== Acute Pharmacotherapies ===  


* For patients with [[Wilson's disease]], copper-chelating agents are recommended
* For patients with [[Wilson's disease]], copper-chelating agents are recommended
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{{WikiDoc Sources}}
{{WikiDoc Sources}}


[[Category:Symptoms]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Signs and symptoms]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Needs patient information]]
[[Category:Needs patient information]]

Latest revision as of 16:11, 3 June 2015

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

Template:Search infobox 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

Template:Diseases of the nervous system


Template:WikiDoc Sources

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