{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:18:59Z","timestamp":1762431539433,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,9]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>A 20-year-old primigravid experienced sudden stiffening of the neck, upper and lower extremities and trunk associated with joint pains. She was generally well before hospital admission with no history of attacks, except for her inflammatory bowel disease that was treated more than a year ago. During physical examination, the patient manifested neck flexion deviated to the right, deviation of the eyes downward and to the right, spooning of the upper extremities, exhibition of milkmaid\u2019s grip, extension of both lower extremities and jerky speech. She also showed uncontrollable tremors of the neck and occasional flailing of upper extremities. Her preliminary laboratory tests were within normal range. It was worth noting here that her family\u2019s medical history was unremarkable. In this article, the process of arriving at the final diagnosis and treatment would be discussed.<\/jats:p>","DOI":"10.1136\/bcr-2018-227112","type":"journal-article","created":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T07:25:09Z","timestamp":1545290709000},"page":"e227112","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Identifying the aetiology of sudden acute abnormal involuntary movements in a primigravid"],"prefix":"10.1136","volume":"11","author":[{"given":"Benjamin Olano","family":"Sosa","sequence":"first","affiliation":[{"name":"College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Anne Balajadia","family":"Toral","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Metro Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,19]]},"reference":[{"key":"2025082713204542000_11.1.e227112.1","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1212\/00132979-200006010-00008","article-title":"Neurological disorders and pregnancy: chorea gravidarum","volume":"6","author":"American Academy of Neurology","year":"2000","journal-title":"Continuum: Lifelong Learning in Neurology"},{"key":"2025082713204542000_11.1.e227112.2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2012-008096"},{"key":"2025082713204542000_11.1.e227112.3","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23071"},{"key":"2025082713204542000_11.1.e227112.4","first-page":"471","article-title":"Chorea","volume":"61","author":"Pandey","year":"2013","journal-title":"J of the Association of Physicians in India"},{"key":"2025082713204542000_11.1.e227112.5","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1212\/01.CON.0000443842.18063.a9","article-title":"Movement disorders in pregnancy","volume":"20","author":"Miyasaki","year":"2014","journal-title":"Continuum"},{"key":"2025082713204542000_11.1.e227112.6","unstructured":"Carapetis RJ . et al Acute rheumatic fever. 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