Papilledema in Sydenham's Chorea

Abstract

There are numerous reports of papilledema in association with various disease entities either with 1,2 or without the presence of increased intracranial pressure.3,4 The association is most frequent with intracranial space occupying lesions such as those produced by brain tumor.5,6 Infection,7,8 trauma,9 heavy metal toxicity,10 and metabolic diseases,11,12 as well as numerous other clinical states have been known for many years to occur with papilledema.13-17 Recently, attention has been redirected to the syndrome of benign intracranial hypertension.18-22This paper reports the findings on an 8\ x =r eq-\ year-old girl studied at the University of Wisconsin Hospitals who had classical physical findings of Sydenham's chorea and papilledema. A search of the world medical literature reveals a marked paucity of reports dealing with the simultaneous occurrence of these conditions. The patient is an 8-year-old white girl who was admitted to the University Hospitals on Oct. 8, 1958, because of involuntary movements of the left extremities and an unsteady gait. About one week prior to admission the patient's mother noticed the onset of involuntary twitches of the left arm and leg, as well as facial grimaces. Several days later, the patient complained of weakness in the left side of her body and began to drag her left leg while walking. The ability to perform fine movements with the left upper extremity had decreased markedly. Except for mild frontal headaches, she had been otherwise asymptomatic. There was no history of nausea, vomiting, diplopia, blurred vision, or head injury.The past medical history, birth, and develop¬ mental history, were normal. Her basic immuniza¬ tions, including poliomyelitis, had been completed.Family history revealed that the father, who is 47 years old, had encephalitis of unknown etiology at the age of 13, and developed Parkinsonism with oculogyric crisis at the age of 32. The mother and 2 siblings have been in good health.Physical examination revealed a well-developed, well-nourished white female child who was alert, cheerful, oriented, and cooperative. There were obvious grimaces involving the facial muscles.The blood pressure was 112/60; pulse, 96 per minute; respirations, 18 per minute, and the rectal temperature was 99.8 F. Examination of the lungs and abdomen revealed them to be normal. Ex¬ amination of the heart revealed the point of maximal impulse to be in the fifth intercostal space in the midclavicular line. There were no thrills palpable. Auscultation of the heart revealed absence of murmurs and the presence of normal sinus rhythm.

Treatments and Outcomes Among Patients with Sydenham Chorea

“…We identified 1479 patients with IPD (median [IQR] age at onset, 10 [8-13] years in 1354 patients; 985 of 1426 [69.1%] female and 441 of 1426 [30.9%] male) were identified from 307 articles…”

Neuro-Ophthalmology

“…55 Repeated studies were made of the arteri¬ al blood, gases, and cerebrospinal fluid pH and pCOs over a 3-month period in a patient with chronic pulmonary insufficiency, papil¬ ledema, and retinopathy. These studies showed that respiratory acidosis causes an accumulation of carbon dioxide in brain tissue, reflected by inversion of the normal carbon dioxide tension ratio between cere¬ brospinal fluid and arterial blood.…”