Osmotic Demyelination Syndrome From Rapid Sodium Correction Causing Evolving Chorea

Segment 1 (18 months after initial presentation): parkinsonism was mostly resolved (had discontinued levodopa therapy several months prior); the primary movement disorder is now a generalized chorea affecting all 4 limbs. There is dystonic posturing of the right hand and neck. Segment 2 (24 months after initial presentation): the generalized chorea is more pronounced, as is his gait abnormality. There is additional development of athetosis in the left hand, most obvious when the hand is held outstretched.