Morning Report August 7, 2012 Good Morning
Chorea **Show video**
Symptoms Acute /subacuteChronic LocalizedDiffuse SingleMultiple StaticProgressive ConstantIntermittent Single EpisodeRecurrent AbruptGradual SevereMild PainfulNonpainful BiliousNonbilious Sharp/StabbingDull/Vague Problem Characteristics Ill-appearing/ Toxic Well-appearing/ Non-toxic Localized problemSystemic problem AcquiredCongenital New problem Recurrence of old problem Semantic Qualifiers
Illness Scripts Predisposing Conditions Age, gender, preceding events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc) Pathophysiological Insult What is physically happening in the body, organisms involved, etc. Clinical Manifestations Signs and symptoms Labs and imaging
Causes of Chorea**
Diffusion-Weighted MRI
Normal Vasculature
MRI-T2
MRI
Predisposing Conditions Bimodal age distribution First decade: 5-7 years old Fifth decade Females > Males (2:1) Asian (especially Japanese) Associations Down’s Syndrome Neurofibromatosis Type 1 Sickle Cell Disease Prior intracranial irradiation Autoimmune/collagen vascular disorders
Pathophysiology Chronic progressive cerebrovascular disorder Progressive stenosis of the terminal portion of bilateral internal carotid arteries Also stenosis of the main branches of the internal carotids (esp. middle and anterior cerebral arteries) This leads to abnormally dilated collateral vessels at the base of the brain Exact cause unknown General vascular dysplasia Genetic involvement? Autoimmune, environmental, infectious?
Clinical Manifestations Results from poor cerebral perfusion and infarction Cause of 6% of pediatric strokes Fixed, unilateral neurologic deficit Often hemiplegia Seizures Involuntary movement disorders Headache Transient Ischemic Attacks Precipitated by crying, coughing, blowing
Imaging CT MRI CT Angiogram (gold standard) “Puff of Smoke”…Moyamoya
Other Treatment Neurosurgical revascularization…has been shown to decrease the risk of stroke Aspirin: prevents micro-thrombi formation at the sites of stenosis Anti-epileptic medications Calcium channel blockers Steroids (as in our patient with chorea) Early diagnosis and surgical management are important Long-term outcome is most closely related to patient’s neurologic status at diagnosis and treatment
Thanks!! Noon conference = YOGA (12:15)