Sydenhams chorea
Sydenham’s chorea (or “St Vitus” dance) is a neurologic disorder characterized by emotional lability and uncoordinated, involuntary, and often asymmetric movements of the face, hands, and feet. The “ milkmaid’s grip ” (involuntary, repeated grasp, and release of an examiner’s finger by a subject attempting to hold a constant grip) is pathognomonic. Sensation is not affected. The choreiform movements disappear during sleep. The latent interval between streptococcal pharyngitis and chorea onset may be prolonged, frequently >6 to 8 weeks. Consequently, ASO titers may be normal, although ADB may still be elevated. Brain magnetic resonance imaging shows inflammation in the basal ganglia. Therapy is symptomatic. Symptoms can last 2 to 4 months and may be the only manifestation of ARF, although this manifestation is associated with RHD in up to 33% of patients. Patients may also be at risk for future neuropsychiatric disorders such as an obsessive compulsive disorder (OCD).
