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Lopes et al. Neuroimmunol Neuroinflammation 2016;3:260-1 Neuroimmunology and
DOI: 10.20517/2347-8659.2016.45
Neuroinflammation

www.nnjournal.net
Letter to Editor Open Access

Isolated unilateral chorea: a diagnostic

challenge

Marta Lopes, Eva Brandão

Department of Neurology, Hospital São Sebastião, Entre Douro e Vouga Hospital Centre, 4720-411 Santa Maria da Feira, Portugal.
Correspondence to: Dr. Marta Lopes, Department of Neurology, Hospital São Sebastião, Entre Douro e Vouga Hospital Centre, 4720-411 Santa
Maria da Feira, Portugal. E-mail: marta.fmup@gmail.com
How to cite this article: Lopes M, Brandão E. Isolated unilateral chorea: a diagnostic challenge. Neuroimmunol Neuroinflammation 2016;3:260-1.
Article history: Received: 27-10-2016 Accepted: 29-10-2016 Published: 18-11-2016

Dr. Marta Lopes is a neurology resident in Centro Hospitalar de Entre o Douro e Vouga, located at Santa Maria da
Feira, a beautiful city in northern Portugal. The areas of scientific interest are headaches, sleep disorders, stroke,
neurosonology and neuroimmunology.

Movement disorders of paraneoplastic etiology involuntary movements of the left arm with one-month
are very rare, representing solely about 1% of all evolution, without any other complaint. At neurological
paraneoplastic neurological syndromes. The most examination, it was clear a unilateral chorea of
[1]
frequently associated carcinoma is small-cell lung the left limbs, worse in the left arm. The remaining
cancer, although several others are reported such examination was unremarkable. Treatment with
as hematologic, bowel, breast, prostate and bladder. risperidone and haloperidol were tried, without any
It was reported an association with CV2/CRMP5, symptom improvement. An etiology was extensively
Anti-Hu/ANNA, CASPR2 and Yo antibodies, which sought. The cerebral magnetic resonance imaging was
are detectable in serum in most cases, isolated or normal. Hu/ANNA1-Ab and CV2/CRMP5-Ab in serum
in association. [1-4] However, in a minority of cases an were negative. The patient refused a search for other
autoantibody cannot be detected. The antibody most antibodies and a lumbar puncture. A thoracic computed
[1]
frequently associated with paraneoplastic chorea is tomography revealed a mass in the superior lobe of the
CV2/CRMP5, followed by Anti-Hu/ANNA. In a PNS left lung. The biopsy allowed the diagnosis of a small-
EuroNetwork cohort only 1/13 patients presented cell lung cancer. The patient started on chemotherapy
[1]
with unilateral chorea. seven months after the first symptoms and
radiotherapy afterwards. Light respiratory complaints
We present the case of a 62-year-old woman, smoker, (dry cough) started only after the first chemotherapy
who was observed in a neurology clinic because of cycle, approximately nine months after the beginning

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