• Chorea
• Antiphospholipid syndrome

A 74-year-old woman gave a 6-month history of headache and intermittent face and arm movements. On initial examination, there were subtle right arm and leg choreiform movements. Her blood tests showed a low platelet count of 129×10⁹/L (150–400), international normalised ratio of 1.2 (<1.4), erythrocyte sedimentation rate of 23 mm/first hour (<30), positive lupus anticoagulant, weakly positive anticardiolipin IgG at 25 IgG phospholipid units, positive IgM at 20 IgM phospholipid units and negative β₂ glycoprotein-1. Eight weeks later, her symptoms progressed to manifest as continuous profound oromandibular choreiform movements (see online supplementary video 1 and figure 1), resulting in speech arrest and interfering with eating. Repeat blood tests showed persistent weakly positive anticardiolipin antibodies with positive lupus anticoagulant and a low platelet count. We gave her a trial of warfarin for probable antiphospholipid syndrome.1 Further investigations ruled out potential secondary antiphospholipid syndrome. Two weeks later, her choreiform movements resolved (see online supplementary video 2 and figure 2), as did her headaches. She has since been symptom-free for 18 months.

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Figure 1

Still frame of online supplementary video 1.

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Figure 2

Still frame of online supplementary video 2.

Although she had no history of pregnancy failure or recurrent thromboembolic events—required to meet the diagnostic criteria of definite antiphospholipid syndrome—the positive laboratory findings and clinical manifestation of chorea suggested probable antiphospholipid syndrome.2 This syndrome may involve any organ. Chorea comprises 1.3% of its neurological manifestations, although its cause is still poorly understood.

Chorea has only a few treatable causes. Antiphospholipid syndrome is one of them, and recognising the clinical and laboratory manifestations and instituting a trial of treatment can produce a good clinical outcome.