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).

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