Acute chorea: case series from the emergency room of a Brazilian tertiary-level center
ABSTRACT Background: Chorea is a movement disorder characterized by random, brief and migratory involuntary muscle contractions. It is defined as acute when present within hours to days. Three main causes for this scenario have emerged as most likely: vascular, toxic-metabolic and inflammatory. O...
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Thieme Revinter Publicações
2021-03-01
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| Series: | Arquivos de Neuro-Psiquiatria |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000300233&tlng=en |
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| author | Guilherme Diogo SILVA Jacy Bezerra PARMERA Monica Santoro HADDAD |
| author_facet | Guilherme Diogo SILVA Jacy Bezerra PARMERA Monica Santoro HADDAD |
| author_sort | Guilherme Diogo SILVA |
| collection | DOAJ |
| description | ABSTRACT Background: Chorea is a movement disorder characterized by random, brief and migratory involuntary muscle contractions. It is defined as acute when present within hours to days. Three main causes for this scenario have emerged as most likely: vascular, toxic-metabolic and inflammatory. Objectives: To identify the prevalence of the main etiologies and major clinical findings of acute chorea in the emergency room of a tertiary-level referral center; and to suggest an approach for guiding the diagnostic workup and clinical management. Methods: We retrospectively reviewed the clinical aspects and neuroimaging data of 10 patients presenting with acute chorea at the neurological emergency room of our hospital from 2015 to 2019. Results: Stroke was the most common etiology (50% of the cases). All of them were ischemic. It was noteworthy that only one case demonstrated the classical ischemic topographic lesion at the contralateral subthalamic nuclei. Regarding nonvascular etiologies, nonketotic hyperglycemia was the major cause, followed by drug-related chorea. One patient showed inflammatory etiology, which was probably Sydenham chorea reactivation. Conclusion: Acute chorea is an uncommon and challenging problem at the emergency room, often associated with potentially treatable causes. We suggest that use of the acronym DANCE (Diagnosis of chorea, Acute stroke protocol, Normal glucose levels, Check neuroimaging, Exposure to drugs) could form a potential initial approach in the evaluation, in order to emphasize causes that require prompt proper management (e.g. thrombolysis). |
| format | Article |
| id | doaj-art-2ddf1fbcf42f43a2a2f4d104c6548c5d |
| institution | OA Journals |
| issn | 1678-4227 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Thieme Revinter Publicações |
| record_format | Article |
| series | Arquivos de Neuro-Psiquiatria |
| spelling | doaj-art-2ddf1fbcf42f43a2a2f4d104c6548c5d2025-08-20T02:24:07ZengThieme Revinter PublicaçõesArquivos de Neuro-Psiquiatria1678-42272021-03-0179323323710.1590/0004-282x-anp-2020-0124Acute chorea: case series from the emergency room of a Brazilian tertiary-level centerGuilherme Diogo SILVAhttps://orcid.org/0000-0001-9764-3763Jacy Bezerra PARMERAhttps://orcid.org/0000-0002-3565-5328Monica Santoro HADDADhttps://orcid.org/0000-0002-5298-1686ABSTRACT Background: Chorea is a movement disorder characterized by random, brief and migratory involuntary muscle contractions. It is defined as acute when present within hours to days. Three main causes for this scenario have emerged as most likely: vascular, toxic-metabolic and inflammatory. Objectives: To identify the prevalence of the main etiologies and major clinical findings of acute chorea in the emergency room of a tertiary-level referral center; and to suggest an approach for guiding the diagnostic workup and clinical management. Methods: We retrospectively reviewed the clinical aspects and neuroimaging data of 10 patients presenting with acute chorea at the neurological emergency room of our hospital from 2015 to 2019. Results: Stroke was the most common etiology (50% of the cases). All of them were ischemic. It was noteworthy that only one case demonstrated the classical ischemic topographic lesion at the contralateral subthalamic nuclei. Regarding nonvascular etiologies, nonketotic hyperglycemia was the major cause, followed by drug-related chorea. One patient showed inflammatory etiology, which was probably Sydenham chorea reactivation. Conclusion: Acute chorea is an uncommon and challenging problem at the emergency room, often associated with potentially treatable causes. We suggest that use of the acronym DANCE (Diagnosis of chorea, Acute stroke protocol, Normal glucose levels, Check neuroimaging, Exposure to drugs) could form a potential initial approach in the evaluation, in order to emphasize causes that require prompt proper management (e.g. thrombolysis).http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000300233&tlng=enChoreaDyskinesiaStrokeEmergenciesMovement Disorders |
| spellingShingle | Guilherme Diogo SILVA Jacy Bezerra PARMERA Monica Santoro HADDAD Acute chorea: case series from the emergency room of a Brazilian tertiary-level center Arquivos de Neuro-Psiquiatria Chorea Dyskinesia Stroke Emergencies Movement Disorders |
| title | Acute chorea: case series from the emergency room of a Brazilian tertiary-level center |
| title_full | Acute chorea: case series from the emergency room of a Brazilian tertiary-level center |
| title_fullStr | Acute chorea: case series from the emergency room of a Brazilian tertiary-level center |
| title_full_unstemmed | Acute chorea: case series from the emergency room of a Brazilian tertiary-level center |
| title_short | Acute chorea: case series from the emergency room of a Brazilian tertiary-level center |
| title_sort | acute chorea case series from the emergency room of a brazilian tertiary level center |
| topic | Chorea Dyskinesia Stroke Emergencies Movement Disorders |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000300233&tlng=en |
| work_keys_str_mv | AT guilhermediogosilva acutechoreacaseseriesfromtheemergencyroomofabraziliantertiarylevelcenter AT jacybezerraparmera acutechoreacaseseriesfromtheemergencyroomofabraziliantertiarylevelcenter AT monicasantorohaddad acutechoreacaseseriesfromtheemergencyroomofabraziliantertiarylevelcenter |