Paroxysmal hemichorea after streptococcal infectionclinical and diagnostic findings

Chorea is characterized by abnormal hyperkinetic movements which may be a clinical symptom in a wide array of neurological disorders. This report describes the case of a 7- year-old boy who developed a paroxysmal, rightsided hemichorea three weeks after a throat infection. In correlation to the clinical findings, the area of the left putamen presented with a minimal lesion in diffusion weighted Magnetic resonances imaging which was not further evident two weeks later. Corresponding flour deoxy glucose positron emisson tomograpy showed an increased glucose uptake of the left lentiform nucleus and left frontocentral cortex. Given the serological evidence of streptococcal infection as specific trigger, this case report illustrates not only the importance of neuroimaging data in the differential diagnosis of chorea but also the potential pathophysiological role of immune-mediated reactions as etiological factor.