[Beyond the clinic: neuroimagenological findings in Sydenham chorea]

Sydenham's chorea (SC) is the most common form of acquired chorea in childhood and a neurological manifestation of acute rheumatic fever (ARF). It is characterized by involuntary, rapid, and irregular movements. Although the diagnosis is clinical, neuroimaging can play a valuable complementary role. SC arises from an autoimmune response triggered by a streptococcal infection, targeting the basal ganglia. In some cases, it may be the sole manifestation of ARF. We present two pediatric cases with acute hemichorea. In one of them, chorea was the only clinical manifestation. Brain MRIs showed punctate ischemic lesions compatible with postinfectious vasculitis, allowing exclusion of other causes of vasculopathy and movement disorders. Both patients were treated with valproic acid and aspirin as an antiplatelet agent. Clinical and radiological improvement was observed in both cases, allowing treatment withdrawal after six months without symptom recurrence.