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Chorea Gravidarum — SCE Neurology MCQ

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HardMovement DisordersChorea GravidarumSCE Neurology

A 30-year-old woman presents with involuntary, irregular, non-rhythmic movements of the face, trunk, and limbs that have developed over 2 weeks. She is 14 weeks pregnant. She has no prior neurological history. Blood tests reveal positive anti-streptolysin O (ASO) titre. What is the most likely diagnosis?

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Correct answer: E — Sydenham chorea (chorea gravidarum)

The best answer is “Sydenham chorea (chorea gravidarum)”. Parkinsonian syndromes are distinguished by tempo, symmetry, eye movements, falls, autonomic and cognitive features; treatment is individualised to motor and neuropsychiatric burden. The alternatives “Huntington disease presenting during pregnancy”, “Wilson disease with a new hyperkinetic syndrome”, “Drug-induced tardive dyskinesia without dopamine-blocker exposure”, “Antiphospholipid chorea from active systemic lupus” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG71 Parkinson disease recommendations: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations