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WHAT IS THE CAUSE OF CHOREOATHETOSIS _?
WHAT IS THE CAUSE OF CHOREOATHETOSIS _? 20/02/2010 https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai.

Cite this article  Copy Citation
Shah I. What is the Cause of Choreoathetosis?. Pediatr Oncall J. 2010;7: 25-26.

Address for Correspondence
Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056. India.

Email
info@pediatriconcall.com

Clinical Problem :
A 12 years old HIV infected boy presented with sudden onset left sided choreoathetoid movements which have remained same for past 4 months. There was no fever, headache, vomiting, seizures or altered sensorium. Both parents had died due to AIDS. On examination, apart from left choreoathetosis, there were no other abnormalities. MRI brain showed multiple foci of hyperintense signals in right basal ganglia. CSF examination was normal.
 
Question :
What could be the cause of choreoathetosis _?
 
Expert Opinion :
Basal ganglia involvement in HIV infected children can occur due to:
1. HIV virus itself
2. Granuloma – TB, Toxoplasmosis
3. Vascular infarcts due to thrombotic tendency
4. Progressive multifocal leukoencephalopathy {PML}.

In this child, CSF is normal and MRI does not show any granuloma. Thus, it is unlikely to be TB or toxoplasmosis. Also MRI does not show an infarct, thus it is unlikely to be a thrombus. PML is caused by JC virus, has a progressively downhill course unless treated with ART especially protease inhibitors {PI}. It has characteristic neuroimaging findings which are not present in this child. Also, he has remained the same for past 4 months and not worsened without treatment.

Thus, most likely, it is the HIV virus itself causing the basal ganglia affection. Thus, in an HIV infected child with extrapyramidal disease, one should consider several differential diagnosis.
 
Funding:  None  
 
Conflict of Interest: None
 
DOI No. : 
 
Cite this article as :
Shah I. What is the Cause of Choreoathetosis?. Pediatr Oncall J. 2010;7: 25-26.
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