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Movement Disorders

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A 19-year-old, left-handed woman has had several weeks of nausea, vomiting, and 8 lb of weight gain. She has also noticed the recent onset of an involuntary movement disorder that involves relatively rapid and fluid, but not rhythmic, limb and trunk movements. Which of the following is the most likely diagnosis?

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a. Chorea gravidarum

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b. Huntington chorea

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c. Alzheimer disease

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d. Multiple sclerosis

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e. Amyotrophic lateral sclerosis

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The answer is a. Chorea gravidarum designates an involuntary movement disorder that occurs during pregnancy and involves relatively rapid and fluid, but not rhythmic, limb and trunk movements. This type of movement disorder may also appear with estrogen use, but the fundamental problem is a dramatic change in the hormonal environment of the brain. At the end of pregnancy or with the withdrawal of the offending estrogen, the movements abate. The movements that develop with chorea gravidarum may be quite asymmetric and forceful. Huntington chorea is a progressive, uniformly fatal hereditary disease that does not fit well with the given history. The other choices are not typically characterized by this type of movement disorder.

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The influenza epidemic of 1918 to 1926 was associated with von Economo encephalitis and left many persons with a syndrome indistinguishable from which of the following?

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a. Sydenham chorea

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b. Alzheimer disease

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c. Multiple sclerosis

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d. Amyotrophic lateral sclerosis

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e. Parkinson disease

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The answer is e. A variety of agents can induce signs and symptoms of parkinsonism on a temporary basis, but few will evoke a persistent parkinsonian syndrome. After the epidemic of encephalitis lethargica of 1918 to 1926, there were many cases of postencephalitic parkinsonism. The causative agent was believed to be an influenza virus, but it could not be isolated with the techniques available at the time of the epidemic. Postinfluenzal parkinsonism still develops, but the incidence is too rare to establish that this virus is the only virus capable of producing parkinsonism. Early in the infection, patients may exhibit a transient chorea. As the chorea abates, the parkinsonism appears and persists.

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A 43-year-old man has a father who died from Huntington disease. The son was tested and found to have the gene for Huntington disease. Which of the following is true regarding the offspring of those with Huntington disease?

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a. Half the offspring are at risk only if ...

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