Psychiatric symptoms and transient cognitive impairment in an adolescent with oral conraceptive-induced chorea

Abstract

A case is presented of a 16-year old girl who developed chorea memory loss and psychiatric symptoms within 21 days of initiating oral contraception with Ortho novum 1/35 (ethinyl estradiol 0.35 mg and norethindrone 0.015 mg). From the 3rd day of pill intake she developed slurred speech and poor grasp evolving to chorea of the upper and lower extremities predominating on the right. She became withdrawn depressed defiant and emotionally labile. She was admitted to a psychiatric hospital for inappropriate affect then to a university hospital on day 21 for suspected organic etiology of her movement disorder. Pills were discontinued on day 10. Her psychiatric history included attempted suicide and family history of alcoholism and abuse. All laboratory findings were normal including serum copper ceruloplasmin cerebrospinal fluid myelin basic protein and oligoclonal bands collagen vascular screen serum and cerebrospinal fluid viral titers pregnancy test anti-streptolysin O titers anti-hyaluronidase titers and anti-caudate nuclear antibodies. Re-exam 12 days after admission during treatment with haloperidol 0.25 mg showed improvement in memory chorea and dysarthria. She was still mildly depressed. She was discharged 25 days after admission with a normal neurologic exam to a foster home. The findings suggest that although memory impairment in a patient with oral contraceptive-associated chorea is novel the suspected lesion site the basal ganglia may involve memory function. Pill patients with chorea should be evaluated for cognitive dysfunction.