Chorea

Chorea (Gk. choreia, a dance), or St. Vitus' Dance, is a remarkable disease, occurring for the most part in children, the most prominent feature of which is the presence of irregular disorderly muscular movements.

Causaticn. The disease mainly affects children between 5 and 15 years of age; it is more common in females than in males. It often develops in rheumatic subjects, and like acute rheumatism it is frequently associated with disease of the valves of the heart. The onset of the disease is very often attributed to sudden fright. Chorea is sometimes met with in association with pregnancy.

Symptoms. There is commonly an initial period in which the child is out of sorts, dull, and listless, and then it is noticed that there is an inability on the part of the patient to exercise the natural control over muscular actions. Irregular convulsive movements are observable in different parts of the body. The shoulder is hitched up; the fore-arm and hand seem irresistibly impelled to execute curious purposeless movements; the lower extremities are also involved; the facial muscles by their contraction lead to the production of unexpected and inappropriate grimaces; the head is thrown from side to side; the tongue suddenly jerked out, perhaps bitten by the teeth. All these tumultuous movements are exaggerated by the attempt to use the muscles in a legitimate way, and thus, when the patient tries to hold objects in the hand, to walk, or to speak, the disordered movements interfere in a pronounced manner with the appropriate actions, and hinder or even render impossible the movements which he intends to carry out. These convulsive disorders, though by far the most striking, are by no means the only symptoms of the disease. There is nearly always some degree of paralysis of the affected muscles; loss of sensation, too, may occur; and there is often actual loss of intelligence. Palpitation is not, uncommon, and auscultation of the heart, not infrequently reveals the presence of valvular disease. In severe attacks of chorea the distress of the patient is very great, he is continually "on the move," he can only be fed with difficulty, sleep is seriously interfered with, bruises and injuries of various kinds may be sustained, and bed sores are apt to prove a formidable complication. In the majority of instances the disease assumes a mild form, and, unless aggravated by inappropriate treatment, tends to subside in four or six weeks; unfortunately, however, it is apt to recur.