“Postpump” Chorea

  • Roongroj Bhidayasiri
  • Daniel Tarsy
Part of the Current Clinical Neurology book series (CCNEU)


Postpump chorea is characterized by choreoathetoid movements which sometimes appear in children following cardiopulmonary bypass surgery, usually within 2 weeks of surgery. Approximately 1% of children who have cardiac surgery develop this syndrome. The mean age of affected individuals is 8–34 months. Risk factors include deep hypothermia and circulatory arrest. This syndrome is often later associated with developmental delay and neurological deficits ranging from mild learning disabilities to progressive hypotonia with obtundation. Chorea can be transient or persistent. Neuroimaging usually reveals brain atrophy without focal abnormalities. The mechanism for this syndrome is not entirely clear, but the literature suggests it may be the result of microembolic phenomena of air, fat, shards of polyvinylchloride tubing, antifoaming agents, and/or platelet fibrin aggregates accumulated during surgery.

Supplementary material

The child is irritable and has choreiform movements of the face and tongue protrusions with less chorea in the extremities. Occasionally, there are ballistic movements of the left arm. Fine tremulous movements were observed in the extremities. She has severe truncal hypotonia.

Postpump Chorea.mp4 (MP4 21,628KB)


  1. 1.
    Medlock MD, Cruse RS, Winek SJ, et al. A 10-year experience with postpump chorea. Ann Neurol. 1993;34:820–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Wong PC, Barlow CF, Pr H, et al. Factors associated with choreoathetosis after cardiopulmonary bypass in children with congenital heart disease. Circulation. 1992;86:118–26.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Roongroj Bhidayasiri
    • 1
    • 2
  • Daniel Tarsy
    • 3
  1. 1.Chulalongkorn Center of Excellence on Parkinson’s Disease and Related DisordersChulalongkorn University HospitalBangkokThailand
  2. 2.Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of NeurologyHarvard Medical School Beth Israel Deaconess Medical CenterBostonUSA

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