Chorea gravidarum is becoming a rare entity in clinical practice, but its early recognition is vital in preventing both maternal and fetal morbidity and mortality [1]. The clinical presentation is distinguished by the onset of involuntary, non-rhythmic, non-repetitive and abrupt but brief movements of any of the limbs (known as chorea) during the first trimester of pregnancy [1] [2] [3]. Based on the extent of body involvement, several forms are recognized - generalized, focal, multifocal or hemichorea (involving only one side of the body) [4]. The appearance of facial grimaces slurred speech and impaired coordination may accompany this movement disorder [1] [2] [3]. In the majority of cases, chorea is self-limiting, and spontaneously resolves after pregnancy, but rare cases of spontaneous abortion were documented [4] [5]. Huntington's disease, drug-induced chorea, Wilson's disease, thyrotoxicosis, systemic lupus erythematosus (SLE), and syphilis have all been confirmed as possible causes, but in the absence of an evident etiology, many cases are diagnosed as idiopathic [1] [5]. However, history of rheumatic fever (particularly in developing countries where it is widely present) and use of oral contraceptives, as well as antiphospholipid syndrome, are the most important causes of chorea gravidarum, and they are also potent risk factors for recurrence of chorea in subsequent pregnancies [1] [4] [6].

• Movement Disorder

  Read More Movement disorders in pregnancy. [pubfacts.com]

  […] complicates a pre-existing movement disorder. [scienceopen.com]

  Antineuronal antibodies in movement disorders. Pediatrics. 1993 Jul. 92(1):39-43. [Medline]. Swedo SE, Leonard HL, Garvey M, et al. [emedicine.com]

  Movement Disorders in Neurologic and Systemic Disease provides comprehensive coverage of the most common movement disorders seen in systemic and general neurologic disease, as well as differential diagnostic and therapeutic algorithms. [books.google.com]

• Pain

  No history of rheumatic fever, joint pains, neuropsychiatric abnormality, skin rash, or long-term drug ingestion was elicited. She admitted to having a positive VDRL for the past six years, antedating any sexual contact. [jamanetwork.com]

  Issues Specialties Addiction Medicine Cardiology Dermatology Diabetes Endocrinology Gastroenterology Geriatrics Hematology Hepatology Hospice & Palliative Medicine Immunology Infectious Diseases Men's Health Mental Health Nephrology Neurology Oncology Pain [mdedge.com]

  […] on endovascular neuroradiology, parkinsonian syndromes, Lewy body dementias, frontotemporal dementia, vanishing white matter, vasculitis, normal pressure hydrocephalus, neuromyelitis optica, Kennedy disease, spinal muscular atrophy, complex regional pain [books.google.de]

  She reported history of similar episode of fever associated with joint pain in the left wrist and right knee, which was relieved spontaneously in 2 days and was followed by pain in left elbow joint (fleeting joint pain) at the age of 15 years. [ncbi.nlm.nih.gov]

• Falling

  Falls cited a rare case that proved to be Huntington’s chorea. The woman went through labor and delivered the baby and the baby lived. He did not feel it was necessary t.o induce labor. [kundoc.com]

  With the taming of tions occurred when she was falling asleep and at the streptococcal infections, it is now rare, but still occurs, Journal Archives of Women's Mental Health – Springer Journals Published: Mar 1, 2006 [deepdyve.com]

  Patient had h/o syncopal attack and fall 10 years back which was associated with fever and headache for which she had taken treatment at a local hospital. [go.gale.com]

  Motor features include: impairment of involuntary (chorea) and voluntary movements; reduced manual dexterity, slurred speech, swallowing difficulties, balance problems and falls. [movementdisorders.org]

  Drug-induced movement disorders fall into the same phenomenologic categories (chorea, dystonia, myoclonus, and tremor) but often are considered as a separate entity because of their specific causes and treatments. [pedsinreview.aappublications.org]

• Swelling

  Pallor (+ ++), no icterus, cyanosis, clubbing, lymphadenopathy, no swelling in the neck. Systemic Examination In cardiovascular system pansystolic murmur heard in the mitral area. Respiratory system--normal vesicular breath sounds heard. [go.gale.com]

  Pathology of rheumatic brain disease is of a nonspecific arteritis with endothelial swelling, perivascular lymphocytic infiltration, and petechial hemorrhages. Aschoff bodies are not present in the brain. [medigoo.com]

  Rheumatic brain disease shows pathology of nonspecific arteritis with perivascular lymphocytic infiltration, endothelial swelling and petechial hemorrhages. There is absence of Aschoff bodies. These changes are more apparent in the corpus striatum. [epainassist.com]

  Since initiation of OCP, she noted that her muscles would become painful at times, accompanied by migratory arthralgias and arthritis (with joint swelling and redness) involving the wrist and finger joints. [cureus.com]

  Pathology of rheumatic brain disease is of a nonspecific arteritis with endothelial swelling, perivascular lymphocytic infiltration, and petechial hemorrhages. [emedicine.com]

• Asymptomatic

  History was elicited from her mother who stated that the patient was asymptomatic before and then she started abruptly developing involuntary movements, first in the left upper limb then progressed to all the limbs and also involving tongue. [go.gale.com]

  She was treated effectively with anticoagulants and corticosteroids, and is currently asymptomatic and without treatment. [scienceopen.com]

  Otherwise, prenatal testing is the same as testing an asymptomatic child, which is not ethically recommended. [movementdisorders.org]

  Given the high rates of reported, otherwise asymptomatic strokes, an imaging study is warranted. [medigoo.com]

  Patients who are asymptomatic may become symptomatic during pregnancy and patients who are previously symptomatic may have exacerbation of symptoms. [bhj.org.in]

• Pharyngitis

  Recently there has been a decline in incidence which is probably the result of a decline in rheumatic fever, which was a major cause of chorea gravidarum before the use of antibiotics for streptococcal pharyngitis. U.S. [definitions.net]

  Recently there has been a decline in incidence which is probably the result of a decline in rheumatic fever ( RF ), which was a major cause of chorea gravidarum before the use of antibiotics for streptococcal pharyngitis. 3. [hindlish.in]

  Recently there has been a decline in incidence which is probably the result of a decline in rheumatic fever ( RF ), which was a major cause of chorea gravidarum before the use of antibiotics for streptococcal pharyngitis. [eng.ichacha.net]

  […] patients; the average age is 22 years.[2][3] Recently there has been a decline in incidence which is probably the result of a decline in rheumatic fever (RF), which was a major cause of chorea gravidarum before the use of antibiotics for streptococcal pharyngitis [wikiwand.com]

  Previous use of oral contraceptives, family history of diseases in which chorea is a symptom (for example Huntington's disease) or recent infection by streptococcus pyogenes (primarily pharyngitis) and the subsequent development of rheumatic fever may [symptoma.com]

• Sore Throat

  At 3 weeks prior to her admission in our hospital, she had fever, sore throat and migrating polyarthralgia involving her left wrist followed by left knee joint. [casereports.bmj.com]

  No history of fever with sore throat in the past, however she denied using inj. Penicillin for long time. There was no history of any psychiatric illnesses in the past and no history of any drug intake. Her family history was unremarkable. [go.gale.com]

  Three weeks prior to admission in our hospital, she had fever, sore throat and migrating polyarthralgia involving her left wrist followed by left knee joint. [ncbi.nlm.nih.gov]

• Vascular Disease

  In the past, rheumatic disease was generally the etiology, but today, collagen vascular disease should also be considered. Treatments include neuroleptics for symptomatic relief and therapies targeted toward the underlying pathology. [ncbi.nlm.nih.gov]

  […] collagen vascular disease. [zdoc.site]

  Type Original Articles Copyright Copyright © Canadian Neurological Sciences Federation 1985 References Agrawal, B.Land Foa, RP. (1982) Collagen vascular disease appearing as chorea gravidarum. Arch. [cambridge.org]

  Case report. ( 6405781 ) Lubbe W.F....Walker E.B. 1983 21 Control of chorea gravidarum with haloperidol. ( 7078886 ) Donaldson J.O. 1982 22 Collagen vascular disease appearing as chorea gravidarum. ( 6978125 ) Agrawal B.L....Foa R.P. 1982 23 Chorea gravidarum [malacards.org]

• Pansystolic Murmur

  Systemic Examination In cardiovascular system pansystolic murmur heard in the mitral area. Respiratory system--normal vesicular breath sounds heard. [go.gale.com]

• Cyanosis

  Pallor (+ ++), no icterus, cyanosis, clubbing, lymphadenopathy, no swelling in the neck. Systemic Examination In cardiovascular system pansystolic murmur heard in the mitral area. Respiratory system--normal vesicular breath sounds heard. [go.gale.com]

• Facial Grimacing

  Chorea gravidarum Chorea gravidarum is a rare type of chorea which presents with involuntary abnormal movement, characterized by abrupt, brief, nonrhythmic, nonrepetitive movement of any limb, often associated with nonpatterned facial grimaces. [encyclo.co.uk]

  The appearance of facial grimaces slurred speech and impaired coordination may accompany this movement disorder. [symptoma.com]

• Incontinence

  There was one episode of seizures at that time, generalised tonic clonic type, associated with loss of consciousness lasting for 4-5 mins, not associated with urinary or bladder incontinence. Patient was put on treatment since then. [go.gale.com]

  The diagnostic criteria for NMS (based on the DSM-IV) include the development of severe muscle rigidity and elevated temperature associated with the use of neuroleptic medication with two or more of the following: diaphoresis dysphagia tremor incontinence [ahcmedia.com]

• Amenorrhea

  Ong Medicine, Psychology Movement disorders : official journal of the Movement Disorder Society 2006 We describe cervical dystonia occurring in a 31‐year‐old, previously well, primigravid, primiparous Chinese woman at 4 weeks' amenorrhea, which was ameliorated [semanticscholar.org]

  We describe cervical dystonia occurring in a 31-year-old, previously well, primigravid, primiparous Chinese woman at 4 weeks' amenorrhea, which was ameliorated with low-dose clonazepam and disappeared completely by the end of the second trimester without [pubfacts.com]

• Chorea

  Background Chorea gravidarum (CG) is the term given to chorea occurring during pregnancy. This is not an etiologically or pathologically distinct morbid entity but a generic term for chorea of any cause starting during pregnancy. [emedicine.com]

  Heightened dopaminergic activity in the striatum is postulated as the basis for the chorea. Indications for the use of haloperidol in chorea gravidarum are discussed. [ncbi.nlm.nih.gov]

  Freebase (0.00 / 0 votes) Rate this definition: Chorea gravidarum Chorea gravidarum is a rare type of chorea which presents with involuntary abnormal movement, characterized by abrupt, brief, nonrhythmic, nonrepetitive movement of any limb, often associated [definitions.net]

• Involuntary Movements

  […] chorea [ ko-re´ah ] the ceaseless occurrence of rapid, jerky involuntary movements. adj., adj chore´ic. cho·re·a ( kōr-ē'ă ), Irregular, spasmodic, involuntary movements of the limbs or facial muscles, often accompanied by hypotonia. [medical-dictionary.thefreedictionary.com]

  Any of various disorders of the nervous system marked by involuntary, jerky movements, especially of the arms, legs, and face, and by incoordination. [thefreedictionary.com]

  More: Evidence Summaries Abnormal Involuntary Movements Source: Patient Abnormal involuntary movements (AIMs) are also known as dyskinesias. several varieties of dyskinesia are measured on an Abnormal Involuntary Movements scale. [evidence.nhs.uk]

  The clinical picture is of extrapyramidal symptoms such as involuntary movements, lack of coordination and slurred speech. Neuroleptics or benzodiazepines can be used for treatment. [ncbi.nlm.nih.gov]

  No h/o of any drug prophylaxis taken after that. 2 year later patient was taken to a private hospital with minimal involuntary movements involving only the left upper limb. [go.gale.com]

• Tremor

  Objectives After completing this article, readers should be able to: Identify the important distinguishing features of chorea, dystonia, myoclonus, and tremor. Recognize important causes of chorea, dystonia, myoclonus, and tremor. [pedsinreview.aappublications.org]

  ( Essential tremor, Intention tremor ) · Restless legs · Stiff person Dementia Tauopathy : Alzheimer's ( Early-onset ) · Frontotemporal dementia / Frontotemporal lobar degeneration ( Pick's, Dementia with Lewy bodies ) Multi-infarct dementia Mitochondrial [thefullwiki.org]

  Keywords Parkinson's disease - restless legs syndrome - Tourette syndrome - chorea gravidarum - essential tremor - estrogen - sex differences - pregnancy [thieme-connect.com]

  Tremor is best distinguished by its rhythmicity. [ahcmedia.com]

• Seizure

  While most movement disorders are easily distinguished from seizure on the basis of classic movement patterns and maintenance of consciousness, it is important to reassure parents and caregivers who may be most concerned about a seizure. [ahcmedia.com]

  EEG to exclude seizure.(31356293) Neuroimaging. [emcrit.org]

  There was one episode of seizures at that time, generalised tonic clonic type, associated with loss of consciousness lasting for 4-5 mins, not associated with urinary or bladder incontinence. Patient was put on treatment since then. [go.gale.com]

  Patients may present variable neurological involvement, such as cerebrovascular disease, cognitive dysfunction, headache, seizures, movement disorders, multiple sclerosis-like syndrome, transverse myelitis and ocular symptoms. [scienceopen.com]

  These patients are more likely to develop rhabdomyolysis, seizures, hemiplegia, and coma, with hyperthermia have no history of autoimmune disease, so a full evaluation, particularly poor prognostic factor.The symptoms typically present in the first trimester [medigoo.com]

• Abnormal Involuntary Movement

  More: Evidence Summaries Abnormal Involuntary Movements Source: Patient Abnormal involuntary movements (AIMs) are also known as dyskinesias. several varieties of dyskinesia are measured on an Abnormal Involuntary Movements scale. [evidence.nhs.uk]

  The remaining chapters focus on the abnormal involuntary movements associated with each disease or syndrome. [books.google.com]

  Palanivelu Medicine Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2007 A 20-year-old primipara, of Pakistani origin, referred to the antenatal clinic at term for abnormal involuntary movements and being [semanticscholar.org]

The diagnosis of chorea gravidarum can be made only through a meticulous and complete physical examination that will identify the characteristic abnormal movements. A clinical suspicion must be present if non-rhythmic and abrupt movements are confirmed during the first trimester of pregnancy. In that case, several laboratory tests should be performed [2], in the attempt to establish the underlying cause. Before laboratory testing, a detailed patient history can reveal key information and is a vital component of the diagnostic workup. Previous use of oral contraceptives, family history of diseases in which chorea is a symptom (for example Huntington's disease) or recent infection by streptococcus pyogenes (primarily pharyngitis) and the subsequent development of rheumatic fever may be noted, although only 20-30% of cases have documented evidence of this infection [1]. For this reason, titers of antistreptolysin O (ASO) antibodies, throat cultures, as well as levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and a complete blood count (CBC) are mandatory for exclusion of rheumatic fever as a possible cause [1]. Having in mind the diverse etiology of chorea gravidarum, anticardiolipin antibodies, venereal disease research laboratory (VDRL) test, anti-nuclear antibodies (ANA), ceruloplasmin and urinary copper levels, a full thyroid workup (T3, T4, thyroid-stimulating hormone, or TSH), and assessment of serum electrolytes (primarily calcium and phosphate) must be conducted [1] [2] [5] [7]. In some patients, imaging studies of the endocranium, primarily in the form of magnetic resonance imaging (MRI) may be of great benefit.

Neuroleptics or benzodiazepines can be used for treatment. When antiphospholipid antibodies are shown to be present, corticosteroids, and sometimes aspirin, are added to the treatment. [ncbi.nlm.nih.gov]

She was treated effectively with anticoagulants and corticosteroids, and is currently asymptomatic and without treatment. [scienceopen.com]

Treatment Drug treatment is indicated for patients with severe disabling chorea. [thefullwiki.org]

Maternal and fetal prognosis was good in 6 of 7 cases, there was 1 case of intrauterine growth restriction. Conclusion: Treatment of gestation chorea is primarily expectant and the goal is to reduce symptoms. Maternal and fetal prognosis is good. [go.gale.com]

Prognosis The prognosis of chorea depends on its cause. Huntington's chorea is incurable, leading to the patient's death 10 – 25 years after the first symptoms appear. [encyclopedia.com]

Recurrence of CG in subsequent pregnancies may occur, particularly when associated with antiphospholipid syndrome. [4] Prognosis General prognosis Chorea gravidarum (CG) seldom persists indefinitely. [emedicine.medscape.com]

Prognosis Commonly, Sydenham's chorea is self-limiting with spontaneous remission. Symptoms generally improve in a week or two and are better by 8-9 months, rarely lasting a year; however, they may occasionally wax and wane for up to 10 years. [patient.info]

We believe that, if chorea gravidarum is not accompanied by other etiologic factors (such as antiphospholipid antibodies), there is no elevated risk for the mother and the fetus. [ncbi.nlm.nih.gov]

It is not an etiologically or pathologically distinct morbid entity, but a generic term for chorea of any etiology. We report a case of Chorea Gravidarum who doesn�t have the past h/o Rheumatic fever, Sydenham�s chorea in childhood. [biomedscidirect.com]

It is not an etiologically or pathologically distinct morbid entity, but a generic term for chorea of any etiology. We report a case of Chorea Gravidarum who doesn't have the past h/o Rheumatic fever, Sydenham's chorea in childhood. [zdoc.site]

Huntington's disease, drug-induced chorea, Wilson's disease, thyrotoxicosis, systemic lupus erythematosus (SLE), and syphilis have all been confirmed as possible causes, but in the absence of an evident etiology, many cases are diagnosed as idiopathic [symptoma.com]

Sections address general anatomic, hormonal, epidemiologic, and drug aspects of women's health; neurologic conditions that arise during childhood, pregnancy, adulthood, and old age in females; and particular neurologic conditions that present differently [books.google.com]

Yet, considerable sex differences in epidemiology, clinical features, and treatment exist in these disorders. [thieme-connect.com]

Rheumatic chorea in northern Australia: a clinical and epidemiological study. Arch Dis Child. 1999;80(4):353-358. doi:10.1136/adc.80.4.353 ↑ Zomorrodi A, Wald ER. Sydenham's chorea in western Pennsylvania. [wikem.org]

Arch Intern Med. 1966; 117: 389 Scopus (42) Crossref Google Scholar Lewis-Jonsson J Chorea: its nomenclature, etiology and epidemiology in clinical material from Malmohus County. [amjmed.com]

Pathophysiology Several pathogenetic mechanisms for chorea gravidarum have been offered, but none have been proven. [ipfs.io]

[citation needed] Pathophysiology[edit] Several pathogenetic mechanisms for chorea gravidarum have been offered, but none have been proven. [en.wikipedia.org]

However, she is still seen on follow-up and is on penicillin prophylaxis to prevent rheumatic heart disease. [ncbi.nlm.nih.gov]

1. Kim A, Choi CH, Han CH, Shin JC. Consecutive pregnancy with chorea gravidarum associated with moyamoya disease. J Perinatol. 2009;29(4):317-319.
2. Germes Piña F. Chorea gravidarum. A case report [Article in Spanish]. Ginecol Obstet Mex. 2009;77(3):156-159.
3. Pathania M, Upadhyaya S, Lali BS, Sharma A. Chorea gravidarum: a rarity in West still haunts pregnant women in the East. BMJ Case Rep. 2013;2013:bcr2012008096.
4. Maia DP, Fonseca PG, Camargos ST, Pfannes C, Cunningham MC, Cardoso F. Pregnancy in patients with Sydenham's Chorea. Parkinsonism Relat Disord. 2012;18(5):458-461.
5. Miranda M, Cardoso F, Giovannoni G, Church A. Oral contraceptive induced chorea: another condition associated with anti-basal ganglia antibodies. J Neurol Neurosurg Psychiatry. 2004;75(2):327-328.
6. Karageyim AY, Kars B, Dansuk R, Aygun E, Unal O, Turan MC. Chorea gravidarum: a case report. J Matern Fetal Neonatal Med. 2002;12(5):353-354.
7. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.