A 24 year old right handed Pakistani woman who was eight weeks’ pregnant presented with a two day history of involuntary movements of her left arm, hand. According to Willson and Preece, the first description of chorea with onset during pregnancy (chorea gravidarum) was made by Horstius in The English. A pregnant woman, in her early 20s, presents with chorea following an emotional outburst. While the family members feel it to be a spirit.
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Poliomyelitis Demyelinating disease Transverse myelitis Tropical spastic paraparesis Epidural abscess. Infobox medical condition new All articles with unsourced statements Articles with unsourced statements from May Sign in to save your search Sign in to your personal account. Create a free personal account to access your subscriptions, sign up for alerts, and more. The patient was constantly trying to cover her head with her cloth each time she was having choric movements.
Her symptoms had subsided after taking some antibiotics and analgesics from a local health centre. Archives of Internal Medicine. Amniotic fluid embolism Cephalopelvic disproportion Dystocia Shoulder dystocia Fetal distress Locked twins Obstetrical bleeding Postpartum Pain management during childbirth placenta Placenta accreta Preterm birth Postmature birth Umbilical cord prolapse Uterine inversion Uterine rupture Vasa praevia.
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From Wikipedia, the free encyclopedia. In recent times, most cases of chorea appearing during pregnancy in developed countries were caused by disease entities like systemic lupus erythematosus and Huntington disease. Recently there has been a decline in incidence which is probably the result of a decline in rheumatic fever RFwhich was a major cause of chorea gravidarum before the use of antibiotics for streptococcal pharyngitis. Discussion Chorea is an involuntary abnormal movement characterised by abrupt, brief, non-rhythmic and non-repetitive movement of any limb, often associated with non-patterned facial grimaces.
Insomnia Hypersomnia Sleep apnea Obstructive Congenital central hypoventilation syndrome Narcolepsy Cataplexy Kleine—Levin Circadian rhythm sleep disorder Advanced sleep phase disorder Delayed sleep phase disorder Nonhour sleep—wake disorder Jet lag.
Pregnancy is the time of changing hormonal milieu, it can lower the threshold for chorea and emotional outburst can precipitate it. Migraine Familial hemiplegic Cluster Tension. Ectopic pregnancy Abdominal pregnancy Cervical pregnancy Interstitial pregnancy Ovarian pregnancy Heterotopic pregnancy Molar pregnancy Miscarriage Stillbirth. The positive history of rheumatic fever in the past and precipitation of these symptoms during pregnancy indicated towards the likelihood of chorea gravidarum which was rheumatic in origin.
There is a history of rheumatic fever in the past and examination reveals choreioathetoid jerky movements of her upper limbs with jerky speech, spooning of her limbs and demonstration of milkmaid’s grip. Gestational pemphigoid Impetigo herpetiformis Intrahepatic cholestasis of pregnancy Linea nigra Prurigo gestationis Pruritic folliculitis of pregnancy Pruritic urticarial papules and plaques of pregnancy PUPPP Striae gravidarum.
Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. Copyright American Medical Association. Chorea is an involuntary abnormal movement characterised by abrupt, brief, non-rhythmic and non-repetitive movement of any limb, often associated with non-patterned facial grimaces.
There was no family history of any neurological disease. Sign in to access your subscriptions Sign in to your personal account.
Antistreptolysins antibodies ofPCR 1: A 22 years-old patient, second pregnancy, without prenatal care, who was admitted to the labor at Chorea in this case was helpful to the patient as she was started on penicillin prophylaxis which would prevent development of rheumatic heart disease in future. Several pathogenetic mechanisms for chorea gravidarum have been offered, but none have been proven.
The history was elicited from her mother-in law who told that patient started having abnormal movements of her tongue which progressed to involve her both arms in the time span of a day when she heard the news of her father’s death. The patient’s laboratory investigations did not show any evidence of recent streptococcal infection. SU was the psychiatrist who was regularly advising the patient.
However, the scenario is different in developing countries like India where rheumatic fever still occurs frequently. It mostly occurs in young patients; the average age is 22 years.
She was also on a regular follow-up with a psychiatrist for gtavidarum. Laboratory studies were as shown in table 1. Encephalomyelitis Acute disseminated Gravvidarum Meningoencephalitis. Create a free personal account to download free article PDFs, sign up for alerts, and more.
Create a personal account to register for email alerts with links to free full-text articles. Purchase access Subscribe now. A pregnant woman, in her early 20s, presents with chorea following an emotional outburst.
Therefore, patients with chorea, even in the absence of other manifestations of rheumatic fever, require long-term antibiotic prophylaxis. The involuntary movements in her tongue and arms were neglected as the attendants took her to a local priest chorda it as an evil spirit in the hills.
Chorea gravidarum: a rarity in West still haunts pregnant women in the East
This finding, as well as the persistence of the movement cjorea, uncommon in chorea gravidarum, 2 suggests that the chorea of the patient was related to some other cause, perhaps a stroke. Get free access to newly published articles.
Curr Opin Neurol ; The patient was admitted in a quiet isolated ward and given one dose of benzathine penicillin, iron and calcium supplements were given along with multivitamins. The recurrences can occur in the subsequent pregnancies. This page was last edited on 13 Decemberat Acute fatty liver of pregnancy Gestational diabetes Hepatitis E Hyperemesis gravidarum Intrahepatic cholestasis of pregnancy.
It has been suggested that use of oral contraceptives is an infrequent cause of chorea. National Center for Biotechnology InformationU. Retrieved from ” https: Support Center Support Center. Background Chorea gravidarum is a rare movement disorder of pregnancy.
The present patient was a case of rheumatic chorea without carditis with previous history of rheumatism but she was at risk of developing rheumatic heart disease in future.