In Sydenham chorea, reassure when the disorder is mild and reserve tetrabenazine for disabling cases given the favorable self-limiting prognosis. When chorea presents in an adult without a family history, the workup must systematically exclude SLE, paraneoplastic antibodies, metabolic causes such as thyroid dysfunction, and a full drug history including estrogen and dopaminergic agents before attributing it to any primary disorder.

On a brain MRI, you might see an abnormally high T-two signal localized within the basal ganglia; If the person undergoes functional PET or SPECT imaging, those scans frequently demonstrate a distinct striatal hypermetabolism; However, for cases that prove to be severe or highly refractory, clinicians may utilize dopamine receptor blockers, carbamazepine, corticosteroids, or even intravenous immunoglobulin; Tetrabenazine is widely favored as our first-line choice; Overall prognosis is quite favorable since it is often self-limiting, typically resolving completely within eight to nine months