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Hong CM, Yang SY, Cho M, Baek DW, Ryu HS. Reversible striatal hypermetabolism of acquired chorea associated with polycythemia vera. Acta Neurol Belg 2023; 123:1997-2000. [PMID: 35922731 DOI: 10.1007/s13760-022-02058-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Seok-Yeol Yang
- Department of Neurology, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea
| | - Minsub Cho
- Department of Neurology, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea
| | - Dong Won Baek
- Department of Hematology/Oncology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, 41944, Republic of Korea
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea.
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Raza HK, Chansysouphanthong T, Singh S, Amir A, Raza MW, Zhang Z, Cui G, Chen H. Polycythemia vera complicated by chorea: A case report and the review of Chinese and international literature. Rev Neurol (Paris) 2021; 177:1025-1030. [PMID: 33781561 DOI: 10.1016/j.neurol.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- H K Raza
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China; School of International Education, Xuzhou Medical University, 221002 Xuzhou, China
| | - T Chansysouphanthong
- School of International Education, Xuzhou Medical University, 221002 Xuzhou, China
| | - S Singh
- School of International Education, Xuzhou Medical University, 221002 Xuzhou, China
| | - A Amir
- Central Park Medical College, Lahore, Pakistan
| | - M W Raza
- Hainan University, Haikou, Hainan, China
| | - Z Zhang
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China
| | - G Cui
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China.
| | - H Chen
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China.
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Patel RA, Hall DA, Eichenseer S, Bailey M. Movement Disorders and Hematologic Diseases. Mov Disord Clin Pract 2021; 8:193-207. [PMID: 33553488 DOI: 10.1002/mdc3.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022] Open
Abstract
Background Movement disorders can be associated with or caused by hematological abnormalities. The objective of this review is to highlight features that will aid in the clinician's recognition and treatment of these disorders. Methods MESH terms relevant to movement disorders and hematologic diseases were searched to identify conditions included in this narrative, educational review. Results Several conditions were identified, and they were organized by hematologic categories to include red blood cell abnormalities, white blood cell abnormalities, disorders of clotting and bleeding, hematologic malignancies, and others. Conclusions This review will increase providers' understanding of disorders that include movement disorders and hematologic abnormalities. Basic hematologic laboratories can aid in assessment of these disorders, to include complete blood count/hemogram and peripheral blood smear. Recognition is key, especially in the setting of underlying malignancy, vitamin deficiency, or other disorder in which treatment is available.
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Affiliation(s)
- Roshni Abee Patel
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Deborah A Hall
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Sheila Eichenseer
- Department of Neurology Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Meagan Bailey
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
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Riboldi GM, Frucht SJ. Neurologic Manifestations of Systemic Disease: Movement Disorders. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-020-00659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Billa V, Jose A, Usulumarty D, Singh K. Seizure and hemichorea post renal transplantation: A recipient with heterogeneous risk factors - A case report. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rodrigues V, Lopes C, Marcolino A, Pinto M. Chorea, Pruritus and Polycythemia: Looking for Clues. Eur J Case Rep Intern Med 2019; 6:001039. [PMID: 30931269 PMCID: PMC6432831 DOI: 10.12890/2019_001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 11/12/2022] Open
Abstract
Chorea is a movement disorder usually due to vascular, hereditary, metabolic or drug-induced causes, and has rarely been reported in association with polycythemia vera (PV). Polycythemic chorea is an uncommon clinical entity that occurs more often in elderly women. PV is a treatable cause of chorea and must be considered during the diagnostic approach. We report the case of a 75-year-old woman with involuntary movements of the mouth and face with subsequent involvement of the trunk and limbs who was admitted for investigation of the chorea. The patient had the haematological attributes of PV and a positive mutation in the janus kinase 2 (JAK2) gene, and was therefore treated with hydroxyurea which led to a marked reduction in the chorea and improvement in haematological parameters. Various aetiologies of chorea must be considered in the elderly. The present case illustrates the importance of considering PV in the differential diagnosis, since its treatment leads to chorea resolution, thus avoiding serious complications.
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Affiliation(s)
- Vânia Rodrigues
- Internal Medicine Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Carolina Lopes
- Neurology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Adilson Marcolino
- Neurology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Madalena Pinto
- Neurology Department, Centro Hospitalar de São João, Porto, Portugal
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García-Cabo C, Fernandez-Dominguez J, Mateos V. Sudden hemichorea and frontal lobe syndrome: a rare presentation of unbalanced polycythaemia vera. BMJ Case Rep 2018; 2018:bcr-2017-223867. [PMID: 29764825 DOI: 10.1136/bcr-2017-223867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polycythaemia vera (PV) is an haematological neoplasm that frequently presents neurological symptoms. However, chorea is a rare complication of this disease, occurring in less than 5% of the patients. Cognitive impairment related to PV unbalanced is also a rare complication, and it can improve with proper treatment. We present a 96-year-old-man with acute-onset hemichorea and frontal lobe syndrome with no vascular pathology in the basal ganglia or frontal region. A clear relationship was observed between the onset of involuntary movements and the cognitive impairment and worsening of haematological parameters in the patient. After causal and symptomatic treatment, the patient's clinical status improved. In the elderly, PV must be considered as a cause of acute chorea and sudden cognitive impairment, as early diagnosis leads to effective treatment and prevention of complications.
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Affiliation(s)
- Carmen García-Cabo
- Department of Neurology, Centro Medico de Asturias, Oviedo, Asturias, Spain
| | | | - Valentín Mateos
- Department of Neurology, Centro Medico de Asturias, Oviedo, Asturias, Spain
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Barow E, Hoppe J, Mainka T, Schneider SA, Ganos C. Hematologic Follow-up as Clue to Polycythemia Vera due to JAK2 Mutation Presenting as Late Onset Chorea. Mov Disord Clin Pract 2017; 5:83-85. [PMID: 30746396 DOI: 10.1002/mdc3.12548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/26/2017] [Accepted: 09/02/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ewgenia Barow
- Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Julia Hoppe
- Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Tina Mainka
- Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | | | - Christos Ganos
- Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany
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11
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Degnan AJ, Capek E, Bowman A. Chorea in the older adult: a full blooded answer. J R Coll Physicians Edinb 2016; 46:244-246. [DOI: 10.4997/jrcpe.2016.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Movement disorders, classically involving dysfunction of the basal ganglia commonly occur in neurodegenerative and structural brain disorders. At times, however, movement disorders can be the initial manifestation of a systemic disease. In this article we discuss the most common movement disorders which may present in infectious, autoimmune, paraneoplastic, metabolic and endocrine diseases. Management often has to be multidisciplinary involving primary care physicians, neurologists, allied health professionals including nurses, occupational therapists and less frequently neurosurgeons. Recognizing and treating the underlying systemic disease is important in order to improve the neurological symptoms.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, Innsbruck A-6020, Austria.
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Shimizu M, Ohe M, Ono A, Nam Y, Takei S, Tsuda H, Irie T, Hibino M, Kamei T. [Case report: A case of diabetic chorea associated hyperviscosity without abnormal findings of magnetic resonance imaging]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2014; 103:3103-3105. [PMID: 25812343 DOI: 10.2169/naika.103.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
Chorea is a rare complication of polycythemia. We report the case of a 70 year-old woman whose polycythemia vera (PV), with Janus Kinase-2 (JAK2) mutation, presented as chorea. Chorea resolved quickly after hydroxyurea therapy.
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Affiliation(s)
- Guidong Liu
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jie Chang
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhijun Liu
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qiang Qiang
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chunhui Gu
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yingying Zhang
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
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Ito H, Kinoshita I, Joh T, Otsubo M, Hazama R. [Case report of essential thrombocythemia with sudden onset of hemichorea]. Rinsho Shinkeigaku 2011; 51:211-4. [PMID: 21485168 DOI: 10.5692/clinicalneurol.51.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 68-year-old woman was admitted to our hospital because of sudden onset of involuntary movements, similar to those associated with chorea, of the right side of the body and for further evaluation of thrombocythemia. She had no family history of chorea. Neurological findings did not show any abnormality except for chorea of the right side. Laboratory studies showed increased number of white blood cells (14,000/microl) and platelets (188.3 x 10(4)/ microl). Lupus anticoagulant, anti-cardiolipin antibody, and ceruloplasmin levels were within the normal range. Her NAP score was 240, and result for bcr-abl gene expression was negative. Bone marrow puncture showed hypercellularity and increased number of megakaryocytes (550/microl), but there was no atypism. On the basis of these laboratory findings, she was diagnosed with essential thrombocythemia T1-weighted magnetic resonance imaging (MRI) showed a hyperintense lesion extending from the region around the left globus pallidum to putamen. The MRI findings of our study were similar to those related to diabetic hemichorea; however, the results of some tests did not indicate diabetes mellitus. An MRI scan showing high T1 signal intensity in the basal ganglia might not be specific for diabetic hemichorea. In this case, MRI revealed the cause of hemichorea to be micocirculatory failure or small cerebral hemorrhages.
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Affiliation(s)
- Hiroyuki Ito
- Section of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital
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Abstract
Polycythemia vera is a sporadic myeloproliferative disorder of increased red blood cell mass affecting multiple organ systems. Associated thrombosis, hemorrhaging, and hyperviscosity commonly result in neurological manifestations, sometimes in the form of chorea and ballism. Resultant choreiform movements have been mainly described as generalized with orofaciolingual and appendicular muscle involvement, hypotonia, and hyporeflexia. Chorea has also been uncommonly reported as arising from secondary causes of polycythemia; however, the underlying pathophysiology has not been clearly elucidated. Proposed mechanisms for basal ganglia dysfunction include hypoperfusion due to venous stasis, receptor hypersensitivity in a setting of reduced catecholamine levels, and altered platelet dopamine metabolism. Magnetic resonance imaging and single-photon emission computed tomography perfusion studies have failed to reveal an anatomical or physiological basis for polycythemia vera-associated chorea, yet rare pathological examinations of deceased patients have shown signs of cerebral venous thrombosis and perivenous demyelination. Administration of neuroleptics may suppress abnormal choreiform movement; however, effective management of polycythemia vera requires serial venesections in conjunction with chemotherapy. Appropriate treatment may prolong survival to more than 10 years, although chorea may spontaneously remit, re-emerge with resurgence of disease, or continue indefinitely despite maintenance therapy.
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Affiliation(s)
- Michael M Marvi
- Department of Neurology, University of Southern California, Los Angeles, CA 90033, USA.
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Abstract
Hemiballism is a relatively rare hyperkinetic movement disorder characterized by involuntary, violent, coarse and wide-amplitude movements involving ipsilateral arm and leg. Although classically related to lesions in the subthalamic nucleus, in clinical-radiological series of hemiballism most patients had lesions outside this nucleus, involving mainly other basal ganglia structures. It has been suggested that abnormal neuronal firing patterns in the internal segment of the globus pallidus may be related to the pathogenesis of hemiballism. Stroke is the most common cause, but in recent years an increasing number of patients with hemiballism associated with nonketotic hyperglycemia or with complications of human immunodeficiency virus (HIV) infection have been reported. Contrarily to what was stated in older literature, hemiballism has, in general, a relatively good prognosis. Depending on the underlying causes, many patients may experience spontaneous improvements or remissions. Treatment should be directed to the cause of hemiballism. Symptomatic treatment includes the use of drugs, particularly blockers of striatal D2 dopamine receptors and tetrabenazine. Surgical treatment, especially pallidotomy, is a therapeutic option for the minority of patients with severe persistent disabling hemiballism.
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Affiliation(s)
- Francisco Grandas
- Department of Neurology, Hospital Universitario Gregorio Marañón and Parkinson's Disease and Movement Disorders Unit, Hospital Beata Maria Ana, Madrid, Spain.
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Kandiah N, Tan K, Lim CCT, Venketasubramanian N. Hyperglycemic choreoathetosis: role of the putamen in pathogenesis. Mov Disord 2009; 24:915-9. [PMID: 19243026 DOI: 10.1002/mds.22277] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hyperglycemic choreoathetosis (HC) is an uncommon syndrome often associated with hyperintensity of the basal ganglia on MRI. We performed a retrospective review of cases with HC to characterize the clinical, biochemical, and neuroimaging (CT, MRI, and MR spectroscopy) findings and to propose a mechanism for this syndrome. Seven HC patients with a mean age of 75.1 years, mean blood glucose of 27.4 mmol/L, and mean plasma osmolarity of 313.4 mmol/L were studied. All had MR-T1 hyperintensity of the putamen on the side contralateral to the choreoathetosis. Two patients had additional hyperintensity of the globus pallidus while one also had involvement of the caudate. On MR-T2, 2 patients showed hyperintensity, 2 isointensity, and 3 hypointensity in the putamen. MR spectroscopy showed elevated choline and reduced N-acetylaspartate; two patients also had elevated myoinositol levels. Our findings suggest that the putamen has a central role in HC, and MR spectroscopy supports neuronal dysfunction in the putamen. Biochemical and neuroimaging findings support hyperviscosity as the most plausible mechanism.
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Affiliation(s)
- Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore.
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Lee JE, Shin HW, Sohn YH. Chorea as an Initial Manifestation of Polycythemia Vera. J Mov Disord 2008. [DOI: 10.14802/jmd.08015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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No evidence of perfusion abnormalities in the basal ganglia of a patient with generalized chorea-ballism and polycythaemia vera: analysis using subtraction SPECT co-registered to MRI. Neurol Sci 2008; 29:351-4. [PMID: 18941939 DOI: 10.1007/s10072-008-0994-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 07/18/2008] [Indexed: 10/21/2022]
Abstract
Polycythaemia vera is a well-known cause of symptomatic chorea, however, the pathophysiology of this correlation remains unclear. We report on a patient with generalized chorea-ballism associated with polycythaemia vera, and we present the findings of 99mTc-hexamethylpropylene amine oxime (HMPAO) SPECT done in both the choreic state and the non-choreic state. The SPECT during both the choreic and the non-choreic states did not reveal any definite perfusion changes in specific regions of the brain, as compared with 6 age-matched controls. In addition, the subtraction SPECT co-registered to MRI (SISCOM) analysis did not show any difference in cerebral blood flow during the choreic and non-choreic states. This result suggests that the basic mechanism of chorea associated with polycythaemia vera does not appear to be associated with a reduction in cerebral perfusion to a specific cerebral area, such as the basal ganglia or its thalamocortical connections.
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