Hysterical chorea

Description:

The rheumatic chorea (hysterical chorea, acute chorea, Sydenham's chorea) is observed almost only at persons of children's age, is preferential in cold season. Girls are ill almost twice more often than boys.

Symptoms of the Hysterical chorea:

Its main manifestation are motive disturbances in the form of twitchings of hands and legs (a so-called, choreic hyperkinesia). The origin of a disease is connected with the postponed streptococcal infection; it is considered that the hysterical chorea is an initial symptom of rheumatism and can precede formation of rheumatic cordial defects. Besides. family predisposition to a small chorea is noted; among patients girls prevail that connect with effect of women's hormones. Development of clinical manifestations of a hyperkinesia at a chorea is connected with damage of the nervous structures responsible for coordination of movements and a normal muscle tone - cerebral cortices, a cerebellum and some deep structures of a brain (basal ганглиев).

Muscular weakness, diskoordination of movements and the basic - choreic hyperkinesias are characteristic of clinical manifestations of a chorea. The movements at hyperkinesias bystry, spasmodic, accidentally distributed, strongly vary on the frequency and intensity that makes an impression of "rvanost" of the movement. They are expressed to a thicket in the person, brushes and feet. They can be both unilateral, and symmetric. From the most widespread hyperkinesias - it is hyperkinesias of a throat, language that is shown by indistinctness of the speech and disturbance of swallowing. Trunk muscles usually are not involved in a hyperkinesia, the exception makes the defeat of a diaphragm leading to discontinuous spasmodic breath. Expressiveness of hyperkinesias varies from easy grimacing, awkwardness and a smazannost of the drawing of movements to "a choreic storm" with the massive pathological movements in a face, hands and legs.

The disease proceeds in the form of the attacks of the hyperkinesias which are interrupted by intervals with the normal movements and behavior. The average duration of the attack makes 12 weeks, the thicket is 4-6 months old, occasionally the disease can drag on for 1-2 years. At a third of the patients who transferred a hysterical chorea in the subsequent heart disease develops. At a part of patients can it is long to remain psychological disturbances after attacks of a chorea and formation of cordial defect - weakness, slackness, sleep disorders.

At a small chorea the mental disturbances which are shown in emotional instability, uneasiness, impulsiveness of acts are possible; decrease in memory and concentration of attention is possible. These frustration arise at the very beginning of a disease more often and remain in intervals between attacks of hyperkinesias. At adequate treatment of a disease they completely pass.

Reasons of the Hysterical chorea:

Development of a disease is caused by induction by a hemolitic streptococcus of group A of the specific antibodies which are cross reacting with cytoplasmic antigens of neurons of having a tail and subthalamic kernels and causing damage of data of structures of TsNS; a certain significance in a pathogeny of a disease is attached also to changes of a vascular wall of arterioles and small arteries of a brain.

At a morphological research diffusion degenerative changes of neurons in subcrustal kernels and bark of big hemispheres against the background of perivascular infiltration and the small embolic centers in brain substance come to light.

Treatment of the Hysterical chorea:

Treatment of a chorea comes down to purpose of anti-inflammatory drugs - antibiotics and hormonal means. Their appointment prevents strengthening of complications. For reduction of hyperkinesias appoint anticonvulsants and tranquilizers. The bed rest and good nutrition is also shown.