Chorea Gravidarum Workup

  • Author: Tarakad S Ramachandran, MBBS, FRCP(C), FACP; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Feb 3, 2012
 

Laboratory Studies

  • Maintain a high index of suspicion and vigilance when making the diagnosis of chorea gravidarum and considering the differential diagnosis.
  • Acute rheumatic fever- Erythrocyte sedimentation rate (ESR), throat culture, C-reactive protein, and ASO titer
  • Wilson disease - Serum ceruloplasmin and urinary copper (24 h)
  • Systemic lupus erythematosus - ESR, antinuclear antibody, anticardiolipin antibodies, and lupus anticoagulant assays
  • Phenothiazine reaction history - Therapeutic trial of intravenous (IV) benztropine
  • Polycythemia - CBC, hemoglobin, and hematocrit
  • Hyperthyroidism - Thyroxine (T4), thyroid-stimulating hormone (TSH)
  • Hypoparathyroidism - Serum calcium and phosphate
  • Vascular disease
    • Hypercoagulability of pregnancy; investigations for hyperlipidemia, diabetes, valvular heart disease, hyperviscosity states, hemoglobinopathies, or congenital cerebrovascular disease (moyamoya)
    • In a young patient with cerebral infarction, in the absence of hypertension and atrial fibrillation, vasculitides and thrombophilic tendencies must be considered. Testing for thrombophilia with estimation of anticardiolipin antibody, antithrombin III levels, prothrombin gene, protein S, protein C resistance, and factor V Leiden should be considered.
  • Meningovascular syphilis - Venereal Disease Research Laboratory test (VDRL), fluorescent treponemal antibody absorption test (FTA-ABS)
  • Drugs - Serum levels of anticonvulsants, theophylline, lithium, and tricyclic antidepressants
  • Drug toxicity due to amphetamine and cocaine - Serum levels and urine screening
  • Lead toxicity - Serum lead level
  • Neuroacanthocytosis peripheral smear for acanthocytes
  • Adult-onset Tay-Sachs disease - Assay of serum lysosomal enzymes
  • Husby has described antineuronal antibodies using an immunofluorescent technique in 46% of patients with Sydenham chorea (n = 30) compared with 14% of patients with rheumatic fever (without chorea) (n = 50) and only 1.8-4% of control subjects (n = 203). He further demonstrated a potential correlation between antibody reactivity and the clinical status, with antibody disappearance on chorea remission.[38]
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Imaging Studies

  • Hypoparathyroidism: CT scan may reveal bilateral basal ganglia calcificans.
  • MRI
    • Huntington disease (MRI of the brain to exclude caudate atrophy) and neuroacanthocytosis
    • Wilson disease - Striatal damage
    • Systemic lupus erythematosus, locular infarcts - Small arterial damage
    • Rare basal ganglia tumor
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Other Tests

  • Obtain ECG whenever a suspicion of rheumatic fever exists to exclude carditis. EEG may show evidence of rheumatic encephalopathy.
  • Perform a slit-lamp examination to rule out Kayser-Fleischer rings that would indicate Wilson disease.
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Contributor Information and Disclosures
Author

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Specialty Editor Board

Stephen T Gancher, MD  Adjunct Associate Professor, Department of Neurology, Oregon Health Sciences University

Stephen T Gancher, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and Movement Disorders Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nestor Galvez-Jimenez, MD, MSc, MHA  Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

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