SPECT and MRI findings in Sydenham's chorea.

A recent case report by Konagayal in this journal r findings in a subject wit chorea, with abnormalities ganglia noted on a scan 31 days after the onset of the illness, but normal scans seen at day 45. In our similar case an MRI scan and a single photon emission computerised (SPECT) scan were normal. A 22 year old woman presented with the acute onset of Sydenham's chorea. Three days before admission, she had noted paraesthesia of her left toe, and subsequently developed hemi-chorea of her left arm, face, and leg. Past history included mild asthma, atopic dermatitis, and mild iron deficiency anaemia as a result of menorrhagia. Medications included the oral contraceptive pill, inhaled bronchodilator, and an iron folate preparation. Examination confirmed the left hemi-chorea and hemiballismus with choreic movement of the tongue and face. She had a systolic murmur typical of mitral valve prolapse, but no signs of bac~I terial endocarditis. 2 14 16 18 20 22 Investigations included a normal full (h) blood count and biochemistry, and her antinuclear antigen, fl-human chorionic time during the gonadotrophin, and thyroid function were hze introduction of dotted lines negative or normal. A raised IgG ne in respiratory cytomegalovirus antibody titre indicated past infection. The anti-DNase B titre was elevated but antistreptolysin 0 titre was normal. Brainstem auditory evoked responses, CT, MRI, and SPECT scan of her brain were normal. Serum copper estisteady improvemation was slightly elevated at 23-6 ,umol/l ad PdEFchargted. (NR, 12-22 ,umol/1), and her anticardiolipin ndoPEFplrottds antibody was positive. An EEG showed an hour peroiodsix T excess of theta transients in the right central of msteroid e and parietal head regions. A transoy the PEF. bhe oesophageal echocardiogram was diagnostic yntshePeF.de of rheumatic valvular disease, showing ents are needed thickening of valve leaflets associated with knonn neurolomild stenosis (valve area, 2 cm2; gradient, nedical neurolo4-5 mmHg) and mild regurgitation. tals in England, The left hemi-chorea persisted and oral e a hand held tetrabenazine 25 mg twice daily was started asuring FVC. A with partial amelioration of the movement rology wards in disorder. Penicillin 250 mg was started, and