2 Case history
A 12-year-old female presented to the emergency department of a tertiary
care centre in Nepal with random dance-like involuntary movements
affecting the limbs which gradually increased in frequency and severity
over the course of 2 weeks. The movements initially involved her left
upper and lower limbs, later affected all four limbs, but were not
associated with any changes in the level of consciousness and were
notably absent when asleep. Her history was insignificant except for
sore throat and fever for a few days, 4 months prior, which resolved
without treatment. She did not have any history of altered sensorium,
seizures, degrading school performance, loss of consciousness,
incontinence, fever, vomiting, headache, joint pain, weight loss,
rashes, ulcers, toxin exposure.
On admission, she was a well oriented, well-built prepubertal girl with
generalized choreiform movements, a darting tongue, milkmaid’s grip,
pronator drift and spooning sign. The remaining general and systemic
examinations were normal.