rheumatic chorea
Introduction
Introduction to rheumatic dance disease Rheumatoid chorea, also known as small chorea or Sydenham chorea, is more common in girls aged 5 to 15 years. It is characterized by involuntary, irregular rapid dance movements, decreased muscle tone and mental disorders. The incidence of post-puberty declines rapidly, occasionally in adult women, mainly pregnant women. Encephalitis, diphtheria, chickenpox, measles, whooping cough and other infections, systemic lupus erythematosus and carbon monoxide poisoning can cause this disease. basic knowledge The proportion of illness: 0.0008% Susceptible people: most children aged 5 to 15 Mode of infection: non-infectious Complications: joint pain, erythema
Cause
Causes of rheumatic chorea
Rheumatism (35%):
The disease is closely related to rheumatism, which is often a manifestation of acute rheumatism. The pregnancy-induced chorea of pregnant women is also mostly the recurrence of rheumatic chorea. It can also be seen after scarlet fever, diphtheria and other infectious diseases. The lesions are mainly in the cerebral cortex, striatum, cerebellum, substantia nigra, etc., showing a non-specific reversible inflammatory lesion, vascular congestion in the lesion, perivascular lymphocytes and plasma cells infiltration, and diffuse degeneration of nerve cells.
Prevention
Rheumatoid dance prevention
Small chorea is a common manifestation of rheumatic fever in the brain. About 1/4 of patients have developed rheumatic fever such as joint pain, frequent sore throat, skin erythema, rheumatic heart disease, about 1/2 in or after the disease. A variety of rheumatic fever phenomena occur, so prevention and treatment of rheumatic fever is the key. The disease is slow due to slow onset and early symptoms are not obvious. In children, it can be manifested as distracted, restless, declining academic performance, awkward body movements, etc. Teachers misdiagnosed as having neuroticism or naughty, it should be noted that the disease has a good prognosis, but can recur, and death is often due to complications.
Complication
Rheumatoid chorea complications Complications, joint pain, erythema
The most serious complication of the disease is death.
Symptom
Symptoms of rheumatoid chorea common symptoms ataxia involuntary movement, attention deficit, muscle tension reduction
The disease mostly occurs in children or adolescents aged 5 to 15 years old. Most of them are women, usually with subacute onset. In the early stage, they often have restlessness, irritability, inattention, and other manifestations. note.
First, the symptoms of nervous system damage
(1) Symptoms of the bottom section: manifested as sudden, rapid, irregular, aimless dance-like involuntary movements, often from one side of the limb, and then to the opposite side, more limb symptoms than the lower limbs, even limited On one side, from time to time, there are finger flexion and extension, flipping the spiral arm, kicking the knee and bending the knee, etc. The involuntary movement of the facial muscle can be seen by squeezing the eyebrows, opening the mouth and tongue, etc., as if making a face, the muscles of the trunk can appear sharp and chest, and the back of the spine Twisting and other actions, if it affects swallowing, can cause swallowing when articulating sound and respiratory muscles, dysarthria and irregular breathing, the above involuntary movements are exacerbated during emotional excitement, relieved when quiet, disappears during sleep, and severely disappears almost all day Stop, affect daily life and be unable to stand up and sit.
(B) cerebral cortical symptoms: emotional instability, irritability, often affect sleep and rest, severe cases may have mental confusion and agitation.
(C) cerebellar symptoms: muscle tension is significantly reduced, tendon reflexes weakened or even disappeared, action benzoquinone, ataxia.
Second, systemic symptoms
Most patients have fever, sore throat, tonsillitis, joint pain and other symptoms of rheumatism before or during the course of the disease. Heart rate can increase, heart enlargement and murmur when the heart is affected.
Examine
Rheumatoid chorea examination
Laboratory examination
(1) Serological examination increased white blood cell count, accelerated erythrocyte sedimentation rate, increased C-reactive protein titer, and increased anti-streptolysin "O" titer. Because this disease occurs more often in 2 to 3 months, or even 6 to 8 months after streptococcal infection, many children have often negative for streptococcal examination during dance-like movements. Immune function tests, IgG, IgM, IgA can be increased.
(2) Group A hemolytic streptococcus can be detected by throat swab culture.
2. Other inspections
(1) ECG can have changes in rheumatic heart disease.
(2) EEG non-specific diffuse slow wave and mild voltage changes, a small number of patients have epileptic wave-like episodes.
(3) Imaging examination The CT of most children showed low density lesions and edema in the caudate nucleus. MRI showed that the caudate nucleus, the putamen, and the globus pallidus increased, and the T2-weighted image signal increased, which subsided with clinical improvement. PET shows a high metabolic change in the striatum.
Diagnosis
Diagnosis and diagnosis of rheumatic chorea
diagnosis
According to the age of onset, rheumatism and typical neurological symptoms before or during the course of the disease, it is not difficult to diagnose.
Differential diagnosis
First, habitual sputum: Also more common in children, but its involuntary movements are more limited to certain muscles or muscle groups of stereotyped and repeated forced movements, different from this disease.
Second, tics - slang syndrome: occurs well in male children, the disease is chronic and persistent, and the symptoms are fluctuating. In addition to multiple muscle twitching, there may be involuntary vocalization and abnormal language actions, such as swearing speech and movement.
Third, hepatolenticular degeneration: more in the onset of adolescents, can also show a dance-like involuntary movement, but the onset is slow, progressive aggravation, copper metabolism disorders and family genetic history can be identified.
