Interactive Transcript
0:00
Let's talk about other causes of Chorea,
0:03
namely immunological causes of Chorea that include
0:08
SLE, systemic lupus erythematosus,
0:11
primary antiphospholipid antibody syndrome,
0:14
seen more frequently in women,
0:16
vasculitis,
0:18
including primary intracranial leukocytoclastic vasculitis,
0:22
and paraneoplasia.
0:24
Now, most of these can be differentiated.
0:26
People with lupus do not present simply with a
0:30
putaminal abnormality like we might see here,
0:33
either hemorrhage or an infarct.
0:36
They frequently also have some element
0:39
of vasculitis in the cortex,
0:41
which shows up as a hazy area of hyperintensity
0:45
in the cortical or subcortical area,
0:47
which may or may not enhance
0:49
and may or may not bleed.
0:51
They may also have lacunar infarctions elsewhere
0:55
and an angiogram or an MRA may provide
0:58
a sustainable diagnosis.
1:00
On the other hand,
1:01
primary antiphospholipid antibody syndrome,
1:05
which is seen more frequently in women and
1:08
associated with premature miscarriage,
1:10
is frequently seen with white matter abnormalities
1:14
that are scattered throughout the brain,
1:16
simulating, somewhat, very gentle punctate,
1:19
stippled Binswanger's phenomenon.
1:23
Vasculitis would look just like
1:25
systemic lupus erythematosus,
1:28
while paraneoplastic syndrome is often associated
1:31
not with unilateral but bilateral putaminal abnormalities,
1:36
and more frequently, if we scroll,
1:38
it's not uncommon to see concomitant involvement
1:41
of the cortical areas of the hippocampus and
1:44
perihippocampus and paraneoplastic syndrome.
1:48
So, let's talk a little bit further about these.
1:50
SLE or systemic lupus erythematosus
1:54
and / or primary antiphospholipid antibody syndromes,
1:58
these are classically described
1:59
as the prototypical disorders for autoimmune choreas.
2:03
That doesn't mean they're the only ones.
2:05
These have been reported in the context also of
2:09
paraneoplastic syndromes. In other words,
2:11
it's an immune-mediated phenomenon
2:13
in paraneoplasia as well.
2:15
It's usually associated with the anti-hu, H.U.
2:19
more than the anti-mu antibody complex
2:21
and anti-CRMP-5 antibodies in patients with small
2:27
cell carcinoma of the lung.
2:29
So, if you get a choreiform movement disorder
2:31
in somebody with known small cell,
2:34
you're going to go right to paraneoplasia.
2:37
If you wish, let's move on to a quick discussion
2:40
of infectious choreas.
© 2024 MRI Online. All Rights Reserved.