After workout shaking: Signs, reasons, and prognosis
Post-Pump Chorea (PPC): A Rare Complication of Heart Surgery
Post-pump chorea (PPC) is a rare neurological condition that can occur as a complication of major heart surgery. Characterized by involuntary, dance-like movements, PPC is a movement disorder that affects mainly children, although it can occur in adults as well.
Causes and Risk Factors
PPC is believed to be caused by reversible metabolic damage in the basal ganglia of the brain, which is thought to be a result of hypothermia during surgery. The bypass machine and the dance-like movements of chorea give PPC its name, with "on the pump" referring to having had a cardiopulmonary bypass and "chorea" being Greek for "dance-like."
Risk factors for PPC include circulatory arrest and prolonged, deep hypothermia (DH) during surgery. These factors can lead to damage in the brain, causing the onset of PPC symptoms.
Symptoms and Diagnosis
PPC symptoms may include involuntary, sudden, jerky movements, such as dance-like motions, squeezing and releasing the fingers, and moving the tongue in and out of the mouth. These symptoms may worsen with stress or anxiety and often stop during sleep.
Diagnosis of PPC may involve electroencephalography (EEG), brain CT scan, MRI scan, and looking for other factors that can increase the risk of chorea, such as family history of Huntington's disease, autoimmune diseases, history of stroke affecting the movement center of the brain, rheumatic fever in children, and metabolic disorders.
Treatment Options
Treatment for PPC is not universally established, and management is mostly supportive and symptomatic. Common treatment options include dopamine-depleting agents or antipsychotics, immunomodulatory treatments, and in severe, refractory cases, deep brain stimulation (DBS).
Immunomodulatory treatments, such as corticosteroids and other immunosuppressive agents, may be used empirically given that PPC may relate to ischemic or inflammatory brain injury. However, more specialized cardiology or neurology literature would be necessary for detailed PPC protocols.
Outcomes
The outlook for those with PPC can vary, but it may be a temporary condition that resolves within months. In children, PPC often presents more frequently and may be more severe, but spontaneous improvement over weeks to months is common with supportive treatment. Adults tend to have variable recovery, depending on factors like the extent of brain injury and promptness of treatment. Persistent chorea can occur but many patients improve partially or fully.
Relapse or chronic persistence is rare but possible, necessitating longer-term management. It is important to note that PPC is a relatively rare complication of heart surgery, and the majority of patients do not experience these symptoms.
Conclusion
Post-pump chorea is a rare but serious complication of heart surgery that can cause significant disruption to a patient's life. While there is no universally established treatment regimen for PPC, management is mostly supportive and symptomatic. Immunomodulatory treatments, such as corticosteroids and other immunosuppressive agents, may be considered in PPC cases suggestive of inflammatory mechanisms. The outlook for those with PPC depends on severity and underlying brain injury, with children often showing better recovery potential than adults.
- The basal ganglia in the brain, affected by PPC, are susceptible to reversible metabolic damage caused by hypothermia during heart surgery.
- Other medical-conditions such as family history of Huntington's disease, autoimmune diseases, and metabolic disorders might increase the risk of developing chorea.
- Treatment for PPC may involve medications like dopamine-depleting agents or antipsychotics, immunomodulatory treatments, or in severe cases, deep brain stimulation (DBS).
- The prognosis for PPC varies based on factors like the severity of the condition, age, and promptness of treatment, with children usually showing improved recovery potential compared to adults.
