13th March 2024

A 37-year-old male who recently immigrated to the UK from Pakistan is referred to you after the GP auscultated a mid-diastolic murmur.

A 37-year-old male who recently immigrated to the UK from Pakistan is referred to you after the GP auscultated a mid-diastolic murmur. He is also concerned about what he describes as jerky, irregular movements of the patient’s arms and legs, which have been present for the last 6 months. The patient’s sister mentions she has noticed him being more fidgety and clumsier than usual. He has a history of IgA deficiency and, therefore, is prone to recurrent bacterial infections. He refuses to take antibiotics for these infections as they eventually tend to improve on their own. You suspect rheumatic fever and feel the jerky movements correspond to chorea. In chorea, which part of the central nervous system is typically affected?

Select the SINGLE most appropriate option from the list below. Select ONE option only.