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C9ORF2 C9ORF72 diagnosis, in addition to increasing the spectrum of phenotypes for Ataxia-telangiectasia
Telangiectasia?
mutation? disease other disorders in which chorea may occur less often. A number of Confirm with ATM mutation
Variable phenotype clues in the family and medical history, clinical examination, and
Often upper motor neuron
signs laboratory findings may inform the diagnosis. Whilst we typically
No Reduced penetrance
Variable age of onset consider these simultaneously when evaluating the patient with
chorea, there is a need for an algorithm to generate consideration -feto- Senataxin Yes Ataxia with oculomotor
of some of the rarer etiologies. protein mutation? apraxia type 2
African
Onset in childhood
Huntingtons Yes Junctophilin-3 Yes ancestry? No Peripheral neuropathy
disease-like 2 mutation? (may be This flow chart aims to present the various factors which facilitate Elevated creatine kinase
occult) making the correct diagnosis, and the appropriate testing to Consider AD
Consider AD
Behavioural changes/psychiatric disease Aprataxin spinocerebellar
May have more dystonia/parkinsonism? consider depending upon previous test results. The list of mutation?
ataxias
and X-linked
pathways
10% have acanthocytosis e.g.
No differential diagnoses of chorea is ever-evolving with advances in homozygosity?
the molecular biology of movement disorders. This algorithm Yes
Spinocerebellar ataxia MRI - Fe which is open to further development in the light of new Autoimmune
Yes SCA/DRPLA No Yes Ataxia with oculomotor
1,2,3,17,? in basal knowledge. non-paraneoplastic
mutations? apraxia type 1
DRPLA Onset in childhood syndrome
ganglia This flow chart does not necessarily indicate the temporal course Peripheral neuropathy Neoplasm Negative workup
Ataxia, eye movement abormalities,
Elevated cholesterol
peripheral neuropathy etc are typical, but may
of the diagnostic work-up of chorea, especially if the family history evaluation;
be pure HD phenocopy No hypoalbuminemia
Anti-Hu, Yo, +ve Paraneoplastic
Yes Huntingtons
DRPLA myoclonus, dementia, dystonia
typical is not known, but should be used a guideline to generate the CRMP-5, GAD65 syndrome
disease-like 1?
consideration of various clinical entities in light of the available NMDA, VGCC
Caspr2, LGI-1
Benign hereditary information. .. Creutzfeldt-Jakob
chorea Yes Non- No Prion Single Yes PLEDs? disease
Confirm with TITF-1 MRI findings?
+ve
progressive, mutation? (chorea more common
mutation, although other -ve CSF 14-3-3
no dementia? case? in new variant)
genes implicated Consider atypical forms of
No No AD, X-linked or AR disorders, Confirmed by
depending upon inheritance -ve pathology
?