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What is Chorea Gravidarum?
Choreagravidarum is a rare condition where the patient develops chorea during her pregnancy.1Chorea gravidarum is a complicatedness of pregnancy and it is tie in with eclampsia . This condition is characterize by abrupt , abnormal , involuntary movements that are non - rhythmic , brief and sporadic movements of any limb . These movements are commonly consociate with non - patterned grimacing of the typeface . Chorea gravidarum is not a pathologically or etiologically clear-cut fateful condition , but is a unspecific term used when a woman have chorea from any cause during her pregnancy . Chorea gravidarum is linked with history ofSydenham ’s choreaand is usually find out in young women of about 20 to 22 years . Rheumatic febrility is believe to be a major case of chorea gravidarum . There has been diminution in the incidence of chorea gravidarum because of decrease in the cases of rheumatoid pyrexia .
Cause & Pathophysiology of Chorea Gravidarum
Many pathogenetic processes for chorea gravidarum have been put forwards ; however , none of these have been proven . Majority of the patients had a previous chronicle of either canine chorea or rheumatic fever . Amongst the patients presenting with chorea without any evident carditis , around 20 % of these patient tend to developrheumatic middle diseaseafter some years . About half of the patient meet from chorea that is induced from use of unwritten contraceptives have a old history of chorea , about which 40 % of these have rheumatic line of descent . This get to suggest that endocrine , Lipo-Lutin and oestrogen , can pass to sensitisation of the dopamine receptor and confidential information to chorea in patients who are prone to this knottiness from preexist pathology in the basal ganglion .
Autopsy on the patient with chorea gravidarum has revealed pathologic change such as perivascular degeneration in the caudate nucleus nucleus . Rheumatic wit disease shows pathology of nonspecific arteritis with perivascular lymphocytic infiltration , endothelial extrusion and petechial hemorrhages . There is absence seizure of Aschoff physical structure . These change are more apparent in the corpus striatum . There is severe neuronal loss in the putamen and urodele lens nucleus and these morbid change have been observed in chorea gravidarum ; however , those patients also suffered from cardiac disease . It is think that as the inflammation abates , the canine chorea also resolves with degenerative changes still remaining in the small arterioles .
There is also thought to be a potential family relationship between moyamoya disease and chorea gravidarum . The movements of chorea are thought to go on as a resultant of ischemia or increase dopaminergic sensitivity , which is facilitate by the increase in the distaff internal secretion during pregnancy .
Signs & Symptoms of Chorea Gravidarum
Symptoms of Chorea Gravidarum are experience by the patient in her second or third trimester , specially if the patient also has change in her mental condition such as confusion and tempestuousness . Such mothers or patients are more prone to develop raptus , rhabdomyolysis , unilateral paralysis , hyperthermia and comatoseness . The symptoms of chorea gravidarum normally subside in the mid to late second trimester . There is an elevation in the Anti - streptolysin O antibody , which may keep to remain noble-minded throughout the pregnancy . Patients often also have valvular heart disease ; however , the patients commonly respond well to medical interference , supportive therapy and reassurance .
Diagnosis of Chorea Gravidarum
aesculapian account and forcible examination of the patient is carried out . Various investigations are dribble out to confirm the diagnosis of chorea gravidarum . mental imagery subject field are also important for diagnosis . The different tests and investigations done for substantiation of diagnosing of chorea gravidarum include :
Treatment of Chorea Gravidarum
discourse for chorea gravidarum is opt taking into thoughtfulness the teratogenic risk to the foetus , which is weigh against the benefit to the mother . Haloperidol is thought to give the most effective succor from the symptoms of chorea gravidarum.2Pimozide is also a neuroleptic drug carrying less adverse effects than haloperidol . Phenothiazines can also be prescribed for sickness and disgorgement . Other discourse coming for chorea gravidarum consist of steroids and drugging . Chlorpromazine can also be dictate alone or with diazepam . Other medicines which can be used in chorea gravidarum include risperidone , valproic acid , phenobarbital and chloral hydrate . All these medication are order in wicked and debilitating cases of chorea gravidarum .
It is possible to finagle chorea gravidarum without medicinal drug . Conservative treatment for chorea gravidarum consists of rest for the patient , proper diet and serenity or privacy . Patients who have balmy chorea gravidarum usually are not cognisant of the involuntary movements of chorea . In any font , the unnatural nonvoluntary choreic movements cause more distress to the commentator than the patient .
It should be bear in mind that Chorea Gravidarum is not an indication for untimely suspension of pregnancy or abortion whatsoever .
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