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Journal of Child Neurology
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Restricted Unilateral Sydenham's Chorea: Reversible Contralateral Striatal Hypermetabolism Demonstrated on Single Photon Emission Computed Tomographic Scanning

Marie-Emmanuelle Dilenge, MD

Department of Neurology, Neurosurgery and Nuclear Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada

Michael I. Shevell, MDCM

Department of Neurology, Neurosurgery and Nuclear Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada, msheneu{at}mch.mcgill.ca

Laurent Dinh, MD

Department of Neurology, Neurosurgery and Nuclear Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada

Sydenham's chorea results from group A streptococcus infection and subsequent generation of antineuronal antibodies directed at the caudate nucleus and putamen. Predominantly bilateral, in up to 30% of cases the chorea can be unilaterally restricted. Imaging studies, both structural (magnetic resonance imaging) and functional (positron emission tomography), in patients with bilateral Sydenham's chorea have suggested reversible striatal abnormalities. Two patients with unilateral Sydenham's chorea are presented. Computed tomographic and magnetic resonance imaging were normal in both. However, hexamethylpropylenamine oxime single photon emission tomographic (HMPAO SPECT) studies demonstrated hypermetabolism in the contralateral basal ganglia. Resolution of symptoms in one of the patients coincided with normalization of the SPECT scan. Thus, unilateral striatal hypermetabolism appears to underlie the contralateral chorea observed. ASPECT scan probably should be included in the work-up of new-onset chorea. (J Child Neurol 1999;14:509-513).

Journal of Child Neurology, Vol. 14, No. 8, 509-513 (1999)
DOI: 10.1177/088307389901400805
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