Vascular Pathology Causing Late Onset Generalized Chorea: A Clinico-Pathological Case Report.

Area of Science:

• Neurology
• Pathology
• Geriatrics

Background:

• Chorea can be a symptom of acute stroke, often presenting as hemichorea contralateral to the brain lesion.
• Vascular disease affecting the basal ganglia is a recognized, though rarely proven, cause of generalized chorea.

Observation:

• A 90-year-old female experienced intermittent generalized chorea and hemichorea starting at age 81, progressing to dementia, gait, and sphincter disturbances.
• Neurological workup, including genetic testing for Huntington's disease, was negative. MRI revealed ischemic leukoencephalopathy and lacunar infarcts.
• Post-mortem examination confirmed multiple lacunar infarcts in the basal ganglia and cortex, with minor Alzheimer's disease changes.

Findings:

• The case demonstrates a rare instance of vascular pathology leading to late-onset, intermittent generalized chorea.
• The intermittent nature of chorea may be attributed to cumulative vascular damage or functional disruption within neural circuits.
• The study underscores the importance of considering vascular etiologies in unexplained choreiform movement disorders, particularly in older adults.

Implications:

• This clinico-pathological case contributes to the understanding of rare causes of chorea, emphasizing vascular disease in the basal ganglia.
• The findings suggest that cumulative subcortical vascular lesions can manifest as intermittent chorea and progressive neurological decline.
• Further research into the mechanisms of vascular-induced chorea is warranted, especially concerning late-onset and intermittent presentations.