Coreia gravídica

Chorea gravidarum
Especialidade neurologia, obstetrícia
Classificação e recursos externos
CID-10 G25.5, O99.3
CID-9 646.80
CID-11 113562578
eMedicine 1149725
MeSH D020150
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Coreia gravídica é um transtorno neurológico raro[1], caracterizado por movimentos anormais involuntários (coreia) de membros ou da cara em qualquer fase da gravidez.

Os movimentos são abrupto, breves, sem ritmo, não repetitivos e podem incluir caretas. É uma complicação da gravidez que pode ser associado a eclampsia e seus efeitos sobre os núcleos da base. É mais comum em mulheres que tiveram coréia de Sydenham. Afeta principalmente pacientes jovens, entre 15 e 30 anos.[2][3]

Atualmente está em declínio sua incidência, provavelmente como resultado do declínio se casos de febre reumática, uma das principais causas da coreia gravídica, graças a popularização dos antibióticos para tratar faringite estreptocócica e erisipela antes de causar complicações.

Fisiopatologia

Vários mecanismos patogênicos para a coreia gravídica foram estudados. Antecedente de febre reumática ou de coreia são os maiores fatores de risco. A teoria é de que os estrógenos e a progesterona podem sensibilizar os receptores de dopamina (presumivelmente no corpo estriado) e induzir a coreia em indivíduos que são vulneráveis a essa complicação em virtude da existência prévia de patologia nos gânglios basais.

A relação com a febre reumática foi reforçada por diversos estudos, que mostraram que as mulheres com gravidezes normais antes de febre reumática desenvolveram coreia em gravidezes subseqüentes.[4][5] Pelo menos, 35% dos pacientes têm uma clara história de febre reumática aguda e coréia de Sydenham; 4% das pessoas com a coreia gravídico tinha febre reumática aguda.

Tratamento

O tratamento medicamentoso está indicado para pacientes com coreia grave e incapacitante. Essa coreia é tratada com haloperidol ou [6][7][8] clorpromazina sozinha ou clorpromazina combinada com diazepam ou com pimozida. Clorpromazina é um dos neurolépticos que pode ter menos efeitos adversos do que o haloperidol.[9] Ácido Valpróico, hidrato de cloral, risperidona ou fenobarbital também podem ser usados.[10]

Veja também

Referências

  1. ↑ «Chorea gravidarum». Obstetrics and gynecology. 32. PMID 5742087 
  2. ↑ «Chorea Gravidarum». Archives of Internal Medicine. 49. doi:10.1001/archinte.1932.00150100128011 
  3. ↑ «Chorea Gravidarum». Archives of Internal Medicine. 49. doi:10.1001/archinte.1932.00150110134008 
  4. ↑ «Two cases of chorea in pregnancy». Glasgow Medical Journal 
  5. ↑ «Chorea complicating pregnancy». Northwest Med. 15 
  6. ↑ «Rheumatic chorea controlled with haloperidol». The Journal of Pediatrics. 81. PMID 4643046. doi:10.1016/S0022-3476(72)80272-5 
  7. ↑ «Treatment of Chorea Gravidarum with Haloperidol». Southern Medical Journal. 72. PMID 472859. doi:10.1097/00007611-197909000-00044 
  8. ↑ «Control of chorea gravidarum with haloperidol». Obstetrics and gynecology. 59. PMID 7078886 
  9. ↑ «Pimozide treatment of Sydenham's chorea». Neurology. 40. PMID 2296371. doi:10.1212/wnl.40.1.186 
  10. ↑ Chorea Gravidarum~treatment no eMedicine

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