CHOREA MINOR The prominent symptom in the disease which we designate chorea minor, infectious or Sydenham's chorea is the choreic motor disturb ance. As recently' analyzed by Forster, it is compounded of peculiar reaching "spontaneous movements" and "choreic disturbances of coordination." In this way the well-known characteristic picture is produced.
The character of the movements does not, however, in itself suffice for a diagnosis of minor chorea; the choreic motor disturbance is merely a symptom which also occurs in other organic functional and 11CFVOUS diseases.
Brief mention may be made of simple chronic and progressive chronic family (Huntington's) chorea; hysterical chorea; and the cher& variable des degeneres (Brissaud), which develops in degenerates; electrical chorea; posthemiplegic chorea; and similar more or less partial forms of chorea. They will be referred to again at greater length in discussing the difTerential diagnosis.
Clinical Picture.—Minor chorea is a subacute disease of child hood and early youth, which ends in recovery after a few weeks or months. The choreic motor disturbance, as a rule, affects all the vol untary muscles, although frequently it is more prominent on one side of the body than on the other; the disturbance is never confined to a single extremity; it is never associated with spastic cerebral palsies, like postapoplectic chorea; on the contrary, the eases, without excep tion, exhibit a flaccid, partial paralysis (chorea mollis or paralytica). During sleep the choreic movements cease. The disposition of the pa tients is usually affected; they are given to sudden changes of mood, are readily moved to laughter or tears; there is an utter want of con centration and inability to fix the attention or perform any mental work; the children are excitable and easily frightened. Psychic con ditions are not rare in individuals who have passed the age of child hood.
A definite relation has also been established between chorea minor, rheumatism and endocarditis; this connection is not observed in other forms of chorea and strongly suggests that chorea is to be regarded as an infectious disease.
Our reason for adhering to the general custom of describing the disease among the functional nervous disease:, is that the symptoms of bacterial or microbic infection, such as fever epidernieity, etc., are absent or very insignificant, so that it is apparently at least a pure neurosis.
The pathologic findings in the nervous system that have been reported so far, aside from the cardiac lesions, which must for the present be disregarded, are not of the character or importance to alter our opinion in regard to the nature of the disease. They are either so vague as to lack any pathologic dignity, besides being inconstant, as, for example, the so-called chorea corpuscles: or they are merely the results of the complicating septic or endocarditic diseases, such, for example, as the emboli in the small arteries of the brain, and cannot therefore be regarded as the anatomical counterpart of the clinical symptoms in uncomplicated cases.
In spite of the absence of well-defined pathologic changes in Syden hain's chorea, the fact that the motor disturbances coincide completely with those which exist in symptomatic chorea permits us to draw at least a cautious conclusion in regard to the anatomical localization of the unknown pathologic changes. Boni-differ was the first to observe the combination of choreic spontaneous movements and choreic dis turbance of coordination, n-hieh are characteristic of chorea minor, in a case of tumor of the crura cerebelli. In agreement with the older statements by Gowers and numerous later investigators, we may there fore assume a toxic infectious lesion of the cerebellum, not sufficient to produce gross and anatomical changes, as the cause of chorea minor. According to our present knowledge the localization of the disease in the cerebellum explains the choreic motor disturbance; but the pres ence of psychic anomalies, which we are compelled to locate in the cerebrum, proves that the pathologic changes of chorea minor, what ever they may be, are more or less diffuse and involve the entire cen tral nervous system.