Case of the month: August 1997--a 13 year old girl with progressive movement disorder.

A 13-year-old girl presented with a two year history of declining school performance, loss of coordination, and increased difficulty with sports. The family history was positive for Huntington's disease (HD). An MRI was suggestive for bilateral atrophy of the caudate. HD is autosomal dominant and the HD gene contains a polymorphic trinucleotide (CAG) repeat, which is expanded beyond 36 CAG repeats in HD. This patient had one normal-sized allele and one abnormally expanded allele with 68 CAG repeats, confirming the clinical diagnosis of HD. Juvenile onset of HD is uncommon, and is associated with unusually large CAG repeat numbers as was observed in this patient.