Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report

Abstract

Central nervous system (CNS) involvement in SARS-CoV-2 is now a known fact, likely due to viral transmission through the olfactory nerve and high brainstem viral load, which also suggests dissemination in the ambiguus and solitary nuclei from the respiratory tract via the vagus nerve. 1 Anosmia and ageusia findings are justified by a potential large cohort study. It may only be an interesting coincidence that hyposmia disorders are normal in premature Parkinson's disease (usually only in the prodromal phase) and the olfactory system is an early favored site for alpha-synuclein linked diseases. 2 Chorea is a hyperkinetic movement disorder characterized by involuntary brief, sudden and irregular movements. 3 Chorea patients may not recognize irregular movements immediately since they are discreet, and some gestures can be temporarily blocked by parakinesia. The inability to maintain voluntary contraction, as observed during the milkmaid grip test and in individuals with persistent tongue protrusion, is a characteristic of chorea. Chorea can cause irritability and gaucheness. Chorea can be hereditary or acquired, generalized or localized and can have several etiologies, such as viral infection and acute stroke. A 58-year-old male, with known hypertension and no travel history, was brought to the emergency room (ER) at 1:00 pm with complaints of abnormal movements of the hands and feet with an inability to talk properly. The patient was very irritable during the initial ER visit, and intravenous (IV) midazolam was given to control movements. Consultation with the neurology department was requested (Supplementary Video 1 in the online-only Data Supplement). The neurology resident on duty re

Re: Comments on “Chorea as a Presentation of SARS-CoV-2 Encephalitis: A Clinical Case Report”

“…The first video of the patient showed abnormal movements that were involuntary, abrupt, nonstereotyped, irregular, sometimes large-amplitude, and unpredictable on the right leg and arm, defined as chorea by the authors. 2 However, as pointed out in the letter, 3 myoclonus was also observed in the first video, and all abnormal movements in the other videos appear to be myoclonus. 2 Therefore, the patient may have a combination of abnormal movements due to both myoclonus and chorea.…”

“…2 However, as pointed out in the letter, 3 myoclonus was also observed in the first video, and all abnormal movements in the other videos appear to be myoclonus. 2 Therefore, the patient may have a combination of abnormal movements due to both myoclonus and chorea.…”

Sars‐Cov‐2 in a Patient with Acute Chorea: Innocent Bystander or Unexpected Actor?

“…We reviewed the relevant literature published up to April 2021 and extracted three reports of acute chorea with mild signs of encephalopathy and evidence of concurrent Covid‐19 (see Table 1). 4–6 All the patients had mild‐to‐moderate leukocytosis and absence of oligoclonal bands in the CSF. Our case, the only one with CSF follow‐up, suggests that the immune response, in the absence of an effective immunomodulating therapy, can persist for a long time after resolution of the triggering event.…”

Acute-onset chorea and confusional state in 77-year-old COVID-19 patient: a case report

“…In a prospective study by Ray et al [8] on the prevalence of COVID-19 neurological manifestations among 1,334 children, two cases of acute chorea were reported. Byrnes et al [9], Hassan et al [5] and Cotta Ramusino et al [10] reported COVID-19-associated chorea in adults, most probably due to non-infectious encephalitis. Ghosh et al [11] reported a case of chorea in the course of diabetic ketoacidosis triggered by SARS-CoV-2 infection.…”