Chorea: Difference between revisions
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<div class="editorbox"> '''Original Editor '''- [[User:Muskan Rastogi|Muskan Rastogi]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | <div class="editorbox"> '''Original Editor '''- [[User:Muskan Rastogi|Muskan Rastogi]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | ||
==Introduction== | ==Introduction== | ||
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== Diagnosis == | == Diagnosis == | ||
The phenomenological features mentioned above are observed to make a diagnosis of chorea. | |||
=== Differential Diagnosis === | === Differential Diagnosis === | ||
Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient. These symptoms serves as diagnostic clues and are present as 3 body distributions and other crucial features. | |||
1.On Forehead- Huntington Disease. | |||
Wiggling of the eyebrows or activation of the frontalis muscle is present. | |||
2. On Orobuccolingual region- Tardive Chorea, Acquired Hepatocerebral Degeneration ,Chorea-acanthocytosis, Lesch-Nyhan syndrome, PKAN([[dystonia]]), Lubag Disease([[dystonia]]). | |||
Bonbon sign and problem of inappropriate intake of food is seen which cause biting of lips and tongue. | |||
3.Localized to the contralateral subthalamic nucleus(hemichorea)- Nonketonic hyperglycemia, Polycythemia vera, Sydenham Chorea, Others. | |||
Some disorders which are differentially diagnosed are given in the table below- | |||
{| class="wikitable" | |||
|+ | |||
!Disorder/Symptom | |||
!Differentiating Factor from chorea | |||
|- | |||
|Dystonia | |||
|Predictable patterned movements | |||
|- | |||
|Dystonic Tremor | |||
|Irregular and jerky does not have a flowing quality like chorea | |||
|- | |||
|Myoclonic jerks | |||
|Randomness quality of chorea differs the two | |||
|- | |||
|Tics | |||
|Presence of premonitory urge and suppressibility | |||
|- | |||
|Stereotypies | |||
|Has stereotypic movement as if the video is running on a repetitive loop | |||
|- | |||
|Large amplitude cerebellar outflow tremor | |||
|Regular oscillation around the axis and activation of tremor with movements( postural and kinetic components) | |||
|} | |||
== Management == | == Management == |
Revision as of 11:25, 25 August 2022
Introduction[edit | edit source]
The word Chorea has Greek origins meaning "to dance". It has a dance-like appearance due to the random and flowing quality of the movement. Chorea is a type of hyperkinetic movement disorder. The involuntary movements flow from one body area to another which cannot be predicted beforehand.
Causes[edit | edit source]
They are predominantly of 2 types
- Acquired Causes
- Genetic Causes
Phenomenological Features[edit | edit source]
- Randomness
- Flowing Quality
- Parakinesia-Patients blend their chorea-induced movements with their own normal movements.
- Motor impersistence- the patient is unable to perform sustained motor activities.
- Ballism- Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
- Athetosis-Slow writhing movements involving distal limbs sometimes may be facing.
- Varying velocity of movements-quick velocity and low-amplitude movements accompanied by jerks.
This video displays the dance-like movements performed by a patient.
Diagnosis[edit | edit source]
The phenomenological features mentioned above are observed to make a diagnosis of chorea.
Differential Diagnosis[edit | edit source]
Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient. These symptoms serves as diagnostic clues and are present as 3 body distributions and other crucial features.
1.On Forehead- Huntington Disease.
Wiggling of the eyebrows or activation of the frontalis muscle is present.
2. On Orobuccolingual region- Tardive Chorea, Acquired Hepatocerebral Degeneration ,Chorea-acanthocytosis, Lesch-Nyhan syndrome, PKAN(dystonia), Lubag Disease(dystonia).
Bonbon sign and problem of inappropriate intake of food is seen which cause biting of lips and tongue.
3.Localized to the contralateral subthalamic nucleus(hemichorea)- Nonketonic hyperglycemia, Polycythemia vera, Sydenham Chorea, Others.
Some disorders which are differentially diagnosed are given in the table below-
Disorder/Symptom | Differentiating Factor from chorea |
---|---|
Dystonia | Predictable patterned movements |
Dystonic Tremor | Irregular and jerky does not have a flowing quality like chorea |
Myoclonic jerks | Randomness quality of chorea differs the two |
Tics | Presence of premonitory urge and suppressibility |
Stereotypies | Has stereotypic movement as if the video is running on a repetitive loop |
Large amplitude cerebellar outflow tremor | Regular oscillation around the axis and activation of tremor with movements( postural and kinetic components) |
Management[edit | edit source]
1. Dopamine-depleting agents
2. Dopamine D2 receptor-blocking agents
3. Anticonvulsants
4. Anti-glutamatergic agents
5. Cannabinoids
6. Deep Brain Stimulation
7. Physiotherapy