SYDENHAM’S CHOREA

SYDENHAM’S CHOREA

(St. Vitus’ dance, Chorea minor)

DEFINITION

SYDENHAM’S CHOREA is an acute episode of involuntary movement, due to a lesion in the basal ganglia associated with acute rheumatism.

AETIOLOGY

Contraceptive pills, pregnancy and mental stress often e precipitate the attack. It is common in temperate climate and in white races. Heredity and left-handedness also play some part. Acute rheumatism is associated with the vast majority of cases but arthritis is usually absent. Pathologically diffuse inflammation of midbrain in seen.

CLINICAL FEATURES

Onset is insidious.

Age 5-15 years.

Sex Common in females.

Psychic changes are initially noted.

The involuntary movements consist of irregular jerky, nonrepetitive quasipurposive movements which may be violent during emotional upsets. The face, tongue and all four limbs may be affected. Muscular tone and jerks are lost. Sometimes there may be subjective weakness of muscles (chorea mollis). If the hands are held forwards with palm down a characteristic flexion of wrist with hyperextension of all finger joints is seen. A peculiar jaunty gait is seen and speech may be affected. Fever is usually absent and ESR is normal but both may alter in presence of carditis. Antistreptolysin 0 litre is normal. Sometimes the same diseased process may reappear in adult life particularly during pregnancy which is called Chorea gravidarum.

PROGNOSIS

Recovery usually occurs within several weeks or months.

TREATMENT OF SYDENHAM’S CHOREA

1. Rest in bed in a railed cot is preferred.

2. Injuries

3. Tranquillisers or sedatives are also helpful. are to be prevented.

4. Prophylactic treatment with antibiotics as in Rheumatic fever for a long time (upto 20 years of age) may be useful in preventing further streptococcal infection.

SYDENHAM’S CHOREA

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