Sydenham's chorea: clinical, EEG, CT scan, and evoked potential studies

Area of Science:

• Pediatric Neurology
• Neurophysiology

Background:

• Acute onset of neurological deficits in children warrants thorough investigation.
• Chorea and mental confusion can indicate various underlying conditions.

Observation:

• An 8-year-old presented with acute mental confusion and choreoathetosis without prior rheumatic fever history.
• Electroencephalography (EEG) revealed focal suppression of sleep spindles and abnormal slow-wave activity.
• Neuroimaging (CT and MRI) did not identify structural lesions correlating with symptoms.

Findings:

• Brainstem auditory evoked potentials were normal.
• Somatosensory evoked potentials showed persistent abnormalities in both acute and recovery phases.
• EEG abnormalities also persisted despite clinical improvement.

Implications:

• Persistent neurophysiological abnormalities suggest a potential subclinical disease process.
• Evoked potentials may serve as sensitive markers for neurological dysfunction in pediatric cases.
• This case highlights the importance of comprehensive neurophysiological assessment in diagnosing unexplained neurological symptoms in children.