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.