The pupils are commonly dilated in chorea and respond sluggishly to light.
REFLEXES.—I have examined the condition of the patellar reflex in 50 cases. In 26 of these it was present in normal degree, in 15 it was diminished, and in 9 it could not be excited. In one patient it was absent during the height of the choreic movements, but could be readily produced after the patient had recovered. The condition of the reflexes has also been examined by Joffroy and Saric,24 and they found that of 16 cases of chorea the reflexes were abolished or diminished in 12.
24 L'Union médicale, Sept. 22, 1885.
SENSIBILITY.—Authors state that disorders of sensation are met with in chorea, such as localized anæsthesia or a general hyperæsthesia: I have never met with any such instances. Patients often complain of pain in the joints or in the limbs, and this may be unaccompanied with swelling or tenderness on pressure. Tenderness on pressure over the vertebræ is rare in my experience, although others speak of its being of frequent occurrence. Mental disorders are generally present, but only to a slight extent. There is almost always irritability of temper and peevishness. The most sweet-tempered children become cross and perverse, laugh immoderately at trifling things, or cry as readily if they are annoyed. There is generally failure of memory and incapacity for study or thought. In most cases, however, this exists to so slight an extent as not to be noticed except on very close observation. Sometimes there is marked mental disorder amounting almost to imbecility, and occasionally the mental weakness remains for some time after the motor disorders have recovered.
The condition of the pulse is generally unchanged, but sometimes it is abnormally frequent. The temperature, according to Von Ziemssen, is unchanged.
The nutrition generally suffers. The patient rapidly loses flesh, and becomes anæmic; the skin grows dry, and the hair gets harsh. The digestion is apt to be disordered. The tongue is large, pallid, and coated thickly, and there is sometimes nausea or vomiting. The appetite is not good. The bowels are often constipated. The urine has been examined by several observers. Bence Jones found an excess of urea at the height of the disease. Albumen is not present except accidentally, but there is usually an excess of phosphates. In several cases in which we have examined the urine at the Infirmary for Nervous Diseases we found that the specific gravity was high while the chorea was at its height, but fell to normal as the patient recovered.
Chorea is spoken of as acute and chronic, but all cases are more or less chronic. Those cases which last eight or ten weeks may be considered acute, while those running on for months or years are properly called chronic.
DURATION.—Considerable difference of opinion exists as to the duration of chorea. Some writers speak of three or four weeks as an average attack. Gray and Tuckwell, in a series of cases treated by the expectant plan,25 found an average duration of ten weeks. Occasionally a patient is seen with an attack of chorea which lasts only a few days. The parents of a little patient whom I saw a few days ago assured me that her second attack lasted only a week. They are educated and intelligent persons whose statement can be relied upon.
25 Lancet, Nov. 28, 1876.