Clinical Vignette:

The appearance of the movement abnormality and the psychiatric symptoms may be separated by many years. Casanova and associates (1995) reported the case of a woman who was diagnosed with Sydenham's chorea at age 5. The abnormal movements abated spontaneously after a few months and never returned. At age 28, she developed auditory and visual hallucinations, delusions of persecution, and antagonistic behavior. Her affect was inappropriate, and she had no insight. She did not respond to treatment with typical neuroleptics. She died at the age of 60. Results of microscopic examination revealed basophilic concretions tracking the vessel walls of the basal ganglia tissue, including at least iron and calcium.