Chorea following SARS-CoV-2 infection and vaccination: a systematic review of reported cases.

Publication date: Jul 07, 2023

Chorea following SARS-CoV-2 infection and vaccination, has been increasingly recognized. We aimed to synthesize clinical and paraclinical characteristics, treatment responses, and outcomes of this neurologic complication. We systematically reviewed LitCOVID, the WHO database on COVID-19, and MedRxiv up to March 2023, following a published protocol. We included 14 chorea cases in patients with SARS-CoV-2 infection and eight following COVID-19 vaccination. Acute or subacute chorea preceded COVID-19 symptoms within 1-3 days or developed up to 3 months after infection. Frequently it was generalized (85. 7%), with associated neurological manifestations (encephalopathy 35. 7%; other movement disorders 7. 1%). After vaccination, chorea had a sudden onset (87. 5%) within two weeks (75%); 87. 5% of cases presented hemichorea, with hemiballismus (37. 5%) or other movement disorders; 12. 5% presented additional neurological findings. CSF was normal in 50% of infected individuals but abnormal in all vaccinated cases. Brain MRI detected normal basal ganglia in 51. 7% of infection cases and 87. 5% following vaccination. IN SARS-COV-2 INFECTION, CHOREA MAY PRESENT SEVERAL PATHOGENIC MECHANISMS: : autoimmune response to infection, direct infection-related injury, or an infection-related complication (i. e., acute disseminated encephalomyelitis, cerebral venous sinus thrombosis, hyperglycemia); also, previous Sydenham chorea may relapse. After COVID-19 vaccination, chorea could be due to an autoimmune reaction or other mechanisms (vaccine-induced hyperglycemia, stroke).

Concepts Keywords
Months chorea
Mri COVID-19
Pathogenic movement disorders
Vaccination SARS-CoV-2
systematic review


Type Source Name
disease MESH Chorea
disease MESH SARS-CoV-2 infection
pathway REACTOME SARS-CoV-2 Infection
disease VO vaccination
disease VO protocol
disease MESH infection
disease MESH encephalopathy
disease MESH movement disorders
disease MESH hemiballismus
disease VO vaccinated
disease MESH autoimmune response
disease MESH acute disseminated encephalomyelitis
disease MESH hyperglycemia
disease VO vaccine
disease MESH stroke

Original Article

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