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.