Differential Diagnosis of Chorea

Chorea is an involuntary movement disorder caused due to varied causes such as Huntington's disease (a progressive and hereditary movement disorder of adults), Sydenham's chorea (a complication of rheumatic fever), drugs (levodopa, anti-convulsants, and anti-psychotics), metabolic and endocrine disorders, and vascular incidents. Besides the irregular, uncontrolled, involuntary, jerky movements other symptoms depend on the basic cause of chorea. Genetic causes

• Huntington disease.
• Huntington disease-like illnesses.
• Neuroacanthocytosis.
• McLeod syndrome.
• Wilson disease.
• Benign hereditary chorea.

Immunologic

• Sydenham’s chorea and variants (chorea gravidarum and contraceptive-induced chorea).
• Systemic lupus erythematosus.
• Antiphospholipid antibody syndrome.

Drug-related

• Amphetamine.
• Anticonvulsants.
• CNS stimulants (methylphenidate, pemoline and cyproheptadine).
• Cocaine.
• Dopamine agonists.
• Dopamine-receptor blockers.
• Levodopa.

Infections

• AIDS related.
• Encephalitis.
• Malaria.

Endocrine-metabolic dysfunction

• Hypocalcaemia (increased blood level of calcium).
• Hypocalcaemia (decreased blood level of calcium).
• Hyperglycaemia (increased blood glucose level).
• Hypoglycaemia (low blood glucose).
• Liver failure.

Vascular

• Stroke.
• Subdural hematoma.

Others

• Cerebral palsy.
• Kernicterus.
• Multiple sclerosis.
• Posttraumatic (brain injury).

Patients with chorea are evaluated using history, neuroimaging and laboratory study. The doctor will take a thorough medical history (current and past medications, family and social history) to help refine the differential diagnosis. MRI scan and CT scan may be done to evaluate the brain. The lab studies may include genetic testing for Huntington disease, HIV antibody testing; muscle biopsy for mitochondrial disease, cerebrospinal fluid analysis for inflammation, and drug or toxin assays. Your doctor will not do all the tests at the same time. Tests are done based in your signs and symptoms and a combination of them may be needed to make a correct diagnosis.

Read more articles on Chorea