Chorea - Revision history

Danbot: Expanded with concise EM-focused content: treatable causes, hemiballismus, hyperglycemia-induced, evaluation, disposition

2026-03-21T00:41:19Z

Expanded with concise EM-focused content: treatable causes, hemiballismus, hyperglycemia-induced, evaluation, disposition

← Older revision		Revision as of 00:41, 21 March 2026
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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}}		{{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==
	{{Movement disorder DDX}}		{{Movement disorder DDX}}

			===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==		==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==

Rossdonaldson1 at 17:12, 12 January 2021

2021-01-12T17:12:53Z

← Older revision		Revision as of 17:12, 12 January 2021
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	==Background==		==Background==
	*Movement disorder		*Movement disorder

			{{Chorea DDX}}

	==Clinical Features==		==Clinical Features==
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{~~Chorea~~ DDX}}		{{Movement disorder DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2021-01-12T16:57:44Z

Differential Diagnosis

@@ Line 7: / Line 7: @@
 ==Differential Diagnosis==
-===Autoimmune===
+{{Chorea DDX}}
 ==Evaluation==

Rossdonaldson1: /* Autoimmune */

2021-01-12T16:53:52Z

Autoimmune

← Older revision		Revision as of 16:53, 12 January 2021
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	==Differential Diagnosis==		==Differential Diagnosis==
	===Autoimmune===		===Autoimmune===
	*Sydenham's ~~Chorea -~~ due to [[acute ~~Rheumatic Fever~~]]		*[[Sydenham's chorea]] (due to [[acute rheumatic fever]])
	*[[Lupus]]		*[[Lupus]]
	*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>		*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>
	*Chorea Gravidarum - usually in 1st trimester pregnancy <ref> Bordelon YM, et al. Movement disorders in pregnancy. Semin Neurol 2007; 27(5):467-475 </ref>		*Chorea Gravidarum - usually in 1st trimester pregnancy <ref> Bordelon YM, et al. Movement disorders in pregnancy. Semin Neurol 2007; 27(5):467-475 </ref>

	===Vascular===		===Vascular===
	*[[Stroke]]		*[[Stroke]]

Rossdonaldson1: /* Clinical Features */

2020-11-11T19:14:15Z

Clinical Features

← Older revision		Revision as of 19:14, 11 November 2020
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	==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).]]
	*Involuntary worm-like movements		*Involuntary worm-like movements

ClaireLewis at 00:24, 3 October 2019

2019-10-03T00:24:13Z

← Older revision		Revision as of 00:24, 3 October 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	===Autoimmune===		===Autoimmune===
	*Sydenham's Chorea - due to [[~~Acute~~ Rheumatic Fever]]		*Sydenham's Chorea - due to [[acute Rheumatic Fever]]
	*[[Lupus]]		*[[Lupus]]
	*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>		*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>
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	===Vascular===		===Vascular===
	*[[Stroke]]		*[[Stroke]]
	*Postpump ~~Chorea~~ - in children after cardiac surgery		*Postpump chorea - in children after cardiac surgery
	*[[Polycythemia ~~Vera~~]]		*[[Polycythemia vera]]
	===Metabolic Disorders===		===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>		*[[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>
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	*[[Theophylline]]		*[[Theophylline]]
	===[[Paraneoplastic]]===		===[[Paraneoplastic]]===
	*Small-cell lung CA		*Small-cell lung cancer

	==Evaluation==		==Evaluation==

ClaireLewis: /* Differential Diagnosis */

2019-01-27T01:34:34Z

Differential Diagnosis

← Older revision		Revision as of 01:34, 27 January 2019
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	*[[Stroke]]		*[[Stroke]]
	*Postpump Chorea - in children after cardiac surgery		*Postpump Chorea - in children after cardiac surgery
	*Polycythemia Vera		*[[Polycythemia Vera]]
	===Metabolic Disorders===		===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>		*[[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>
	*[[Hyperthyroidism]] (rare)		*[[Hyperthyroidism]] (rare)
	*Renal Failure		*[[Renal Failure]]
	*[[Hypocalcemia]]		*[[Hypocalcemia]]
	===Drugs===		===Drugs===
	*Illicit Drugs		*Illicit Drugs
	**[[Cocaine]]		**[[Cocaine]]
	**Methamphetamines		**[[Methamphetamines]]
	*Dopamine Receptor Antagonists		*Dopamine Receptor Antagonists
	**Metoclopramide (Reglan)		**[[Metoclopramide]] (Reglan)
	*Cimetidine		*[[Cimetidine]]
	*[[Digoxin]]		*[[Digoxin]]
	*[[INH\|Isoniazid]]		*[[INH\|Isoniazid]]
	*Verapamil		*[[Verapamil]]
	*Theophylline		*[[Theophylline]]
	===Paraneoplastic===		===[[Paraneoplastic]]===
	*Small-cell lung CA		*Small-cell lung CA

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-21T22:13:27Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 22:13, 21 July 2016
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	*Small-cell lung CA		*Small-cell lung CA

	==~~Diagnosis~~==		==Evaluation==

	==Management==		==Management==

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:42Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:14, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Neuro~~]]		[[Category:Neurology]]

Rossdonaldson1: /* Clinical Features= */

2015-09-02T10:50:21Z

Clinical Features=

← Older revision		Revision as of 10:50, 2 September 2015
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	*Movement disorder		*Movement disorder

	==Clinical Features===		==Clinical Features==
	*Involuntary worm-like movements		*Involuntary worm-like movements