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Lopes et al. Isolated unilateral chorea: a diagnostic challenge

of the chorea. The chorea improved gradually along start of oncological treatment, to allow an improvement
the first four cycles of treatment. She remained with in the prognosis.
occasional weak involuntary movements of the left
hand. Unfortunately, eight months after the beginning Financial support and sponsorship
of the oncological treatment, the disease worsened Nil.
suddenly and she died a few weeks later.
Conflicts of interest
Although the older age, subacute evolution of the There are no conflicts of interest.
symptoms and lack of response to neuroleptics
pointed to a paraneoplastic etiology, the lack of other Patient consent
neurological or systemic symptoms and particularly Written consent was obtained from the patient versed
the strict unilaterality were suggestive of other causes. in the article.
There are only a few reported cases of isolated
unilateral chorea of paraneoplastic etiology. [1,3,4] Ethics approval
This kind of article does not require document for
Our patient started with chorea several months before ethics approval.
the definitive diagnosis of lung cancer was made
and manifested respiratory symptoms only a couple REFERENCES
months after the beginning of chemotherapy. The most
frequently associated antibodies were excluded in 1. Vigliani MC, Honnorat J, Antoine JC, Vitaliani R, Giometto B,
serum and we were unable to pursue the investigation Psimaras D, Franchino F, Rossi C, Graus F; PNS EuroNetwork.
because of patient refusal. A higher rate of detection Chorea and related movement disorders of paraneoplastic origin: the
of paraneoplastic autoantibodies in cerebrospinal PNS EuroNetwork experience. J Neurol 2011;258:2058-68.
fluid and serum when compared to serum alone is 2. Krolak-Salmon P, Androdias G, Meyronet D, Aguera M, Honnorat J,
reported. Therefore, in the present case we can’t Vighetto A. Slow evolution of cerebellar degeneration and chorea in a
[5]
exclude an association of the hemichorea with an man with anti-Yo antibodies. Eur J Neurol 2006;13:307-8.
undetected antibody. 3. Vynogradova I, Savitski V, Heckmann JG. Hemichorea associated with
CASPR2 antibody. Tremor Other Hyperkinet Mov (N Y) 2014;4:239.
4. Vernino S, Tuite P, Adler CH, Meschia JF, Boeve BF, Boasberg P,
We would like to emphasize the great significance of an Parisi JE, Lennon VA. Paraneoplastic chorea associated with CRMP-5
extensive and precocious search for an auto-immune neuronal antibody and lung carcinoma. Ann Neurol 2002;51:625-30.
and, particularly, paraneoplastic cause in patients with 5. McKeon A, Pittock SJ, Lennon VA. CSF complements serum for
late-onset chorea, even when isolated and/or focal, in evaluating paraneoplastic antibodies and NMO-IgG. Neurology
order to provide an early diagnosis and a precocious 2011;76:1108-10.

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