Acute-onset choreiform movements in a previously healthy 4-year-old patient.

[acute rheumatic fever]

We report the case of 4 -year -old male with sinus venous thrombosis leading to bilateral thalamic and basal ganglia strokes presenting as generalized choreiform movements . Acute -onset chorea in the pediatric population is most commonly associated with Sydenham chorea , which is a manifestation of acute rheumatic fever . Chorea is a much less commonly noted sign of stroke , and when it occurs , it typically presents as hemichorea . Given the unlikely presentation , rapid and appropriate imaging was the key to diagnosis .