RESUMEN
STUDY DESIGN: This was an animal study. OBJECTIVES: Local inflammation is attenuated below high thoracic SCI, where innervation of major lymphoid organs is involved. However, whether inflammatory responses are affected after low thoracic SCI, remains undetermined. The aim of this study was to characterize the influence of low thoracic SCI on carrageenan-induced paw swelling in intact and paralyzed limbs, at acute and subacute stages. SETTING: University and hospital-based research center, Mexico City, Mexico. METHODS: Rats received a severe contusive SCI at T9 spinal level or sham injury. Then, 1 and 15 days after lesion, carrageenan or vehicle was subcutaneously injected in forelimb and hindlimb paws. Paw swelling was measured over a 6-h period using a plethysmometer. RESULTS: Swelling increased progressively reaching the maximum 6 h post-carrageenan injection. Swelling increase in sham-injured rats was approximately 130% and 70% compared with baseline values of forelimbs and hindlimbs, respectively. Paws injected with saline exhibited no measurable swelling. Carrageenan-induced paw swelling 1-day post-SCI was suppressed in both intact and paralyzed limbs. Fifteen days post-injury, the swelling response to carrageenan was completely reestablished in forelimbs, whereas in hindlimbs it remained significantly attenuated compared with sham-injured rats. CONCLUSIONS: SCI at low spinal level affects the induced swelling response in a different way depending on both, the neurological status of challenged regions and the stage of injury. These findings suggest that neurological compromise of the main immunological organs is not a prerequisite for the local swelling response to be affected after injury.
Asunto(s)
Inflamación/fisiopatología , Traumatismos de la Médula Espinal/inmunología , Enfermedad Aguda , Animales , Carragenina , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Femenino , Miembro Anterior , Miembro Posterior , Inflamación/patología , Parálisis/inmunología , Parálisis/patología , Distribución Aleatoria , Ratas Sprague-Dawley , Traumatismos de la Médula Espinal/patología , Vértebras Torácicas , Factores de TiempoRESUMEN
Motor neuron (MN) diseases are characterized by progressive cell degeneration, and excitotoxicity has been postulated as a causal factor. Using two experimental procedures for inducing excitotoxic spinal MN degeneration in vivo, by acute and chronic overactivation of α-amino-3-hydroxy-5-methyl-4-isoxazoleacetic acid (AMPA) receptors, we characterized the time course of the neuropathological changes. Electron transmission microscopy showed that acute AMPA perfusion by microdialysis caused MN swelling 1.5h after surgery and lysis with membrane rupture as early as 3h; no cleaved caspase 3 was detected by immunochemistry. Chronic AMPA infusion by osmotic minipumps induced a slow degeneration process along 5days, characterized by progressive changes: endoplasmic reticulum swelling, vacuolization of cytoplasm, vacuole fusion and cell membrane rupture. Quantification of these ultrastructural alterations showed that the increase of vacuolated area was at the expense of the nuclear area. Caspase 3 cleavage was observed since the first day of AMPA infusion. We conclude that acute AMPA-induced excitotoxicity induces MN loss by necrosis, while the progress of degeneration induced by chronic infusion is slow, starting with an early apoptotic process followed by necrosis. In both the acute and chronic procedures a correlation could be established between the loss of MN by necrosis, but not by caspase 3-linked apoptosis, and severe motor deficits and hindlimb paralysis. Our findings are relevant for understanding the mechanisms of neuron death in degenerative diseases and thus for the design of pharmacological therapeutic strategies.
Asunto(s)
Enfermedad de la Neurona Motora/patología , Neuronas Motoras/patología , Degeneración Nerviosa/patología , Médula Espinal/patología , Animales , Apoptosis/fisiología , Astrocitos/metabolismo , Astrocitos/patología , Caspasa 3/metabolismo , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Miembro Posterior , Inmunohistoquímica , Masculino , Microscopía Electrónica de Transmisión , Enfermedad de la Neurona Motora/metabolismo , Neuronas Motoras/metabolismo , Necrosis/metabolismo , Necrosis/patología , Degeneración Nerviosa/metabolismo , Parálisis/metabolismo , Parálisis/patología , Ratas Wistar , Médula Espinal/metabolismo , Factores de Tiempo , Ácido alfa-Amino-3-hidroxi-5-metil-4-isoxazol PropiónicoRESUMEN
A paralisia de laringe (PL) é causada pela perda total ou parcial da inervação dos músculos laríngeos, que promovem adução e abdução das cartilagens aritenóides (CA) e das cordas vocais. Os sinais clínicos correlacionam-se com o grau de paralisia das CA e podem incluir dispnéia inspiratória, estridorlaríngeo, angústia respiratória, intolerância ao exercício, disfonia ou mudança no latido. Uma polineuropatia pode acompanhar a doença respiratória, caracterizando-se por megaesôfago e neuropatias apendiculares. O objetivo deste trabalho é relatar um caso de PL congênita em um cão labrador, fêmea, de dois meses de idade, com grave dispnéia inspiratória, sibilos audíveis, constante posição ortopnéica e aumento dos sons broncovesiculares associado à moderada disfonia. A consecução diagnóstica foi realizada por laringoscopia com sedação superficial, onde se constatou edema das cartilagens laríngeas e paralisia bilateral das CA com difícil visualização do lúmen traqueal. A lateralização cirúrgica das CA como tratamento foi proposto, no entanto a paciente apresentou evolução desfavorável no período pré-operatório e evoluiu negativamente a óbito
The congenital laryngeal paralysis is caused by total or partial disruption of the laryngeal muscles innervation that promotes abduction and adduction of the arytenoids cartilages and vocal folds. The clinical signs correlate with the degree of paralysis of the arytenoid cartilages and are presented with inspiratory dyspneia, laryngeal stridor, respiratory distress, dysphonia or change in bark. A polyneuropathy associated to respiratory disease can be observed, characterized by megaesophagus and peripheral neuropathies. The aim of this paper is toreport a case of congenital laryngeal paralysisin a female Labrador Retriever dog, two months old, presented with inspiratory dyspneia, audible wheezing, orthopnea, increased lung sounds and change in bark. The diagnosis was made by laryngoscopy with superfitial sedation. Laryngeal edema, paralysis of the arytenoid cartilages and difficult visualization of the trachea was observed. The surgical lateralization of the arytenoid cartilages was proposed, but the patient presented complications at preoperative period and evolved negatively todeath
Asunto(s)
Animales , Perros , Perros , Laringe/patología , Parálisis de los Pliegues Vocales/patología , Parálisis de los Pliegues Vocales/veterinaria , Parálisis/patología , Parálisis/veterinariaRESUMEN
A paralisia de laringe (PL) é causada pela perda total ou parcial da inervação dos músculos laríngeos, que promovem adução e abdução das cartilagens aritenóides (CA) e das cordas vocais. Os sinais clínicos correlacionam-se com o grau de paralisia das CA e podem incluir dispnéia inspiratória, estridorlaríngeo, angústia respiratória, intolerância ao exercício, disfonia ou mudança no latido. Uma polineuropatia pode acompanhar a doença respiratória, caracterizando-se por megaesôfago e neuropatias apendiculares. O objetivo deste trabalho é relatar um caso de PL congênita em um cão labrador, fêmea, de dois meses de idade, com grave dispnéia inspiratória, sibilos audíveis, constante posição ortopnéica e aumento dos sons broncovesiculares associado à moderada disfonia. A consecução diagnóstica foi realizada por laringoscopia com sedação superficial, onde se constatou edema das cartilagens laríngeas e paralisia bilateral das CA com difícil visualização do lúmen traqueal. A lateralização cirúrgica das CA como tratamento foi proposto, no entanto a paciente apresentou evolução desfavorável no período pré-operatório e evoluiu negativamente a óbito(AU)
The congenital laryngeal paralysis is caused by total or partial disruption of the laryngeal muscles innervation that promotes abduction and adduction of the arytenoids cartilages and vocal folds. The clinical signs correlate with the degree of paralysis of the arytenoid cartilages and are presented with inspiratory dyspneia, laryngeal stridor, respiratory distress, dysphonia or change in bark. A polyneuropathy associated to respiratory disease can be observed, characterized by megaesophagus and peripheral neuropathies. The aim of this paper is toreport a case of congenital laryngeal paralysisin a female Labrador Retriever dog, two months old, presented with inspiratory dyspneia, audible wheezing, orthopnea, increased lung sounds and change in bark. The diagnosis was made by laryngoscopy with superfitial sedation. Laryngeal edema, paralysis of the arytenoid cartilages and difficult visualization of the trachea was observed. The surgical lateralization of the arytenoid cartilages was proposed, but the patient presented complications at preoperative period and evolved negatively todeath(AU)
Asunto(s)
Animales , Perros , Perros , Laringe/patología , Parálisis/patología , Parálisis/veterinaria , Parálisis de los Pliegues Vocales/patología , Parálisis de los Pliegues Vocales/veterinariaRESUMEN
STUDY DESIGN: Radiographic analysis of sagittal spinal alignment of paraplegics in a standing position under surface neuromuscular electrical stimulation (NMES). OBJECTIVES: Describing the radiographic parameters of the sagittal spinal alignment of paraplegics going through a rehabilitation program with NMES. SETTING: The University Hospital's Ambulatory (UNICAMP), Campinas, São Paulo, Brazil. METHODS: Panoramic X-ray images in profile were taken for 10 paraplegics. All patients participated in the rehabilitation program and were able to perform gait through NMES of the femoral quadriceps muscles. The radiographic parameters used for the analysis were the same as those described in the literature for healthy people. The results were didactically organized into three groups: anatomical shape of the spine, morphology and kinetics of the pelvis and spinopelvic alignment. RESULTS: The physiological curvature of the spine in paraplegics showed average values similar to those described in the literature for healthy patients. The inversion of the pelvic tilt and the increase in the sacral slope were defined by the anterior backward rotation of the pelvis. The existing theoretical mathematical formulas that define lumbar lordosis, pelvic incidence and pelvic tilt showed normal values, despite the anterior intense sagittal imbalance. CONCLUSIONS: The adaptive posture of the spine in paraplegics standing through the stimulation of the femoral quadriceps does not allow for a neutral sagittal alignment. This novel radiographic detailed description of the various segments of the spine can be of assistance toward the understanding of the global postural control for such subjects.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Paraplejía/rehabilitación , Columna Vertebral/fisiología , Adulto , Antropometría , Humanos , Cifosis/patología , Pierna/fisiología , Lordosis/patología , Masculino , Persona de Mediana Edad , Parálisis/patología , Postura/fisiología , Radiografía , Factores Socioeconómicos , Columna Vertebral/anatomía & histología , Columna Vertebral/diagnóstico por imagenRESUMEN
OBJECTIVE: Phrenic nerve transfer has been used for treating lesions of the brachial plexus since 1970. Although, today, surgeons are more experienced with the technique, there are still widespread concerns about its effects on pulmonary function. This study was undertaken to evaluate the effectiveness and safety of this procedure. METHODS: Fourteen patients with complete palsy of the upper limb were submitted to phrenic nerve transfer as part of a strategy for surgical reconstruction of their plexuses. Two patients were lost to follow-up, and 2 patients were followed for less than 2 years. Of the remaining 10 patients, 9 (90%) were male. The lesions affected both sides equally. The mean age of the patients was 24.8 years (range, 14-43 years), and the mean interval from injury to surgery was 6 months (range, 3-9 months). The phrenic nerve was always transferred to the musculocutaneous nerve, and a nerve graft (mean length, 8 cm; range, 4.5-12 cm) was necessary in all cases. RESULTS: There was no major complication related to the surgery. Seven patients (70%) recovered functional level biceps strength (Medical Research Council grade >or=3). All of the patients exhibited a transient decrease in pulmonary function tests, but without clinical respiratory problems. CONCLUSION: On the basis of our small series and data from the literature, we conclude that phrenic nerve transfer in well-selected patients is a safe and effective procedure for recovering biceps function.
Asunto(s)
Neuropatías del Plexo Braquial/cirugía , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Transferencia de Nervios/métodos , Parálisis/cirugía , Nervio Frénico/trasplante , Adolescente , Adulto , Plexo Braquial/fisiopatología , Neuropatías del Plexo Braquial/patología , Neuropatías del Plexo Braquial/fisiopatología , Codo/anatomía & histología , Codo/fisiología , Femenino , Humanos , Masculino , Parálisis/patología , Parálisis/fisiopatología , Nervio Frénico/anatomía & histología , Nervio Frénico/fisiología , Rango del Movimiento Articular/fisiología , Recuperación de la Función/fisiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
The anterior opercular or biopercular syndrome is a cortical pseudobulbar palsy due to bilateral lesions of the anterior brain operculum. It is characterized by preservation of reflex function and automatic activity, without mental impairment. Two cases are reported herein and the relevant literature reviewed. The first case was a 73-year-old female with a history of a stroke occurring seven years previously, without sequelae in the interim. She presented with sudden loss of consciousness. The neurological examination showed a right facial central palsy and anarthria, with reflex acts such as smiling, blinking and yawning, not elicited by commands; she also had a right hemiparesis and walking impairment. A brain CT scan showed an old ischemic infarction in the region of the right medial cerebral artery. Because the right motor involvement did not correlate with the findings of the initial CT scan, another CT scan two days later showed an acute brain infarction in the vicinity of the left medial cerebral artery. The second case was an 8-year-old girl with mental retardation and impairment of verbal development, caused by of biopercular pachygyria. Facio-pharyngo-glosso-masticatory diplegia and volitional selective palsy of the oro-facial muscles was seen in both patients. The neuropsychological assessment showed cognitive, emotional and social interaction impairment in both cases -as part of the frontal convexity syndrome in the first case and of mental retardation in the second. The two patients had difficulty in mastication and swallowing. The prognosis for recovery of verbal capacity is poor, although generally most patients recover the ability to swallow.
Asunto(s)
Encéfalo , Parálisis/patología , Parálisis/fisiopatología , Anciano , Encéfalo/patología , Encéfalo/fisiopatología , Niño , Trastornos de Deglución/etiología , Femenino , Humanos , Trastornos del Lenguaje/etiología , Parálisis/complicaciones , Parálisis/diagnóstico , Pronóstico , SíndromeRESUMEN
Introduccion: El concepto biomecánico de la articulación glenohumeral, generalmente admitido hoy, constituye una limitación para la comprensión de la función real del hombro y un obstáculo para el diagnóstico previo y el tratamiento apropiado de las roturas del manguitode los rotadores complicadas por lesiones del plexo braquial. Materiales y métodos: Se realizó un estudio prospectivo descriptivo de 77 pacientes que presentaron diversas lesiones del manguito de los rotadores del hombro, asociadas con lesiones traumáticas del plexo braquial, que incluían parálisis del músculo deltoides, durante el período comprendido entre 1988 y 2006. Se conformaron cuatro grupos con el objetivo de subrayar el papel determinante y decisivo del manguito de los rotadores para la movilidad activa glenohumeral. Resultados: El grupo de pacientes con lesiones definitivas del nervio axilar presentó un nivel funcional compatible con las actividades de la vida diaria. Las lesiones completas no reparadas del manguito de los rotadores determinaron dolor y pérdida de función aun con la recuperación neurológica. Cuando la lesión del manguito fue reparada el resultado clínico fue favorable en la mayoría de los casos, incluso con la persistencia del compromiso neurológico. Conclusiones: El supraespinoso y el manguito de los rotadores suelen ser el primer motor de la articulación glenohumeral, mientras que el deltoides, por tratarse de un músculo extrínseco con relación a la articulación glenohumeral, es sólo un músculo auxiliar y suspensorio.
Asunto(s)
Adulto , Persona de Mediana Edad , Articulación del Hombro/cirugía , Articulación del Hombro/lesiones , Manguito de los Rotadores/cirugía , Manguito de los Rotadores/lesiones , Plexo Braquial/lesiones , Axila/lesiones , Estudios Prospectivos , Músculos/lesiones , Parálisis/patología , Rango del Movimiento Articular , Resultado del Tratamiento , RoturaRESUMEN
A convenient transgenic astrocytoma model in delta202 mice, homozygous for a construct encoding the early region of the SV40 virus genome, is described. In the offspring of crosses between delta202 mice heterozygous for the transgene nearly 60% were transgenic; one third of these developed progressive paralysis starting in the hindlimbs at approximately 35 days of age and died at 90 +/- 30 days of age. In affected mice proliferating-non-neuronal cells immunostained with antibodies to the GFAP, an astrocyte marker, whose number increased with age were found in the white matter of the brain, cerebellum and spinal cord, and progressive degeneration and necrosis of spinal motoneurons was observed that-may explain the paralysis. The early onset and reproducible time course of the neurological disease suggest that homozygous delta202 mice, whose proliferating astrocytes appear to damage spinal motoneurons, are a useful model to study astrocyte differentiation, function and tumorigenesis.
Asunto(s)
Antígenos Transformadores de Poliomavirus/genética , Astrocitos/patología , Homocigoto , Parálisis/genética , Parálisis/patología , Anaplasia , Animales , Astrocitos/virología , Astrocitoma/genética , Astrocitoma/virología , Huesos/patología , Huesos/virología , Progresión de la Enfermedad , Femenino , Masculino , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos DBA , Ratones Transgénicos , Músculo Esquelético/patología , Músculo Esquelético/virología , Parálisis/virologíaAsunto(s)
Análisis de Elementos Finitos , Caminata/fisiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/microbiología , Enfermedades del Sistema Nervioso Periférico/patología , Estrés Mecánico , Estudios de Casos y Controles , Factores de Riesgo , Fenómenos Biomecánicos , Lepra/complicaciones , Modelos Anatómicos , Parálisis/fisiopatología , Parálisis/microbiología , Parálisis/patología , Progresión de la Enfermedad , Pie/patología , Simulación por ComputadorRESUMEN
Leprosy is one of the most common diseases of peripheral nerves in the world. In Brazil it is particularly frequent, being a major health problem. In tuberculoid leprosy the ulnar nerve is the most common affected nerve. Sometimes there are no skin changes. In these cases in spite of nerve thickening only the nerve biopsy is capable to make a specific diagnosis. We performed a biopsy in the dorsal sensory branch of the ulnar nerve in the hand in 17 patients with ulnar palsy with thickening of the nerve in the elbow, without skin changes. The pathological findings consisted mainly of: loss of fibers (14 cases), inflammatory infiltration (13), fibrosis (12), demyelination and remyelination (9), presence of granuloma (6) and presence of bacilli (5 cases). We conclude that in case of ulnar nerve palsy in leprosy without skin changes, the biopsy of the dorsal sensory branch of this nerve in the hand is a good procedure for the diagnosis of leprosy.
Asunto(s)
Mano/inervación , Lepra Tuberculoide/patología , Parálisis/etiología , Parálisis/patología , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/patología , Nervio Cubital/patología , Adolescente , Adulto , Anciano , Biopsia , Femenino , Humanos , Lepra Tuberculoide/complicaciones , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/diagnósticoRESUMEN
A lepra constitui causa frequente de acometimento de nervos periféricos, em nosso meio. O sistema nervoso periférico é acometido por vezes sem que haja alteraçoes cutâneas: é a chamada forma neurítica pura. Nessa variante, o nervo mais afetado é o ulnar. Nos casos de acometimento isolado de nervos periféricos somente a feitura de biópsia de nervo conduzirá ao diagnóstico. Assim, resolvemos realizar biópsia do ramo sensitivo superficial do nervo ulnar na mao em 17 pacientes com paresia ou paralisia desse nervo e espessamento do mesmo na altura do cotovelo. Os pricnipais achados foram: reduçao do número de fibras mielínicas em 14 casos, infiltrado inflamatório em 13, fibrose em 12, desmielinizaçao e remielinizaçao em 9, presença de granuloma em 6 e visualizaçao do Mycobacterium leprae em 5. Concluímos que a biópsia do ramo sensitivo superficial do nervo ulnar na mao é um bom meio diagnóstico de lepra em pacientes com acometimento desse nervo.
Asunto(s)
Adulto , Persona de Mediana Edad , Femenino , Humanos , Adolescente , Biopsia , Mano/inervación , Lepra Tuberculoide/patología , Parálisis/patología , Enfermedades del Sistema Nervioso Periférico/patología , Nervio Cubital/patología , Lepra Tuberculoide/complicaciones , Lepra Tuberculoide/diagnóstico , Parálisis/etiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/etiologíaAsunto(s)
Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/patología , Lepra Tuberculoide/complicaciones , Lepra Tuberculoide/patología , Monoaminooxidasa/anatomía & histología , Monoaminooxidasa/inervación , Nervio Cubital/patología , Parálisis/etiología , Parálisis/patologíaRESUMEN
Este trabalho relata o caso de uma criança nascida em Pelotas, RS, com estigmas clínicos da síndrome de Moebius, que foi avaliada pelos geneticistas do serviço de aconselhamento genético. A síndrome de Moebius é caracterizada por paralisia congênita, usualmente bilateral dos músculos retos e da expansäo facial. A anomalia é causada por fatores que agem entre a quarta e sétima semana de vida intrauterina. A variabilidade das manifestaçöes clínicas podem ser explicadas pelo fato de diferentes estruturas nervosas serem afetadas durante a embriogênese. Seräo discutidos critérios para a realizaçäo do diagnóstico, bem como aspectos etiopatogênicos da síndrome
Asunto(s)
Humanos , Masculino , Recién Nacido , Anomalías Congénitas/genética , Parálisis Facial/congénito , Parálisis/patologíaRESUMEN
We report a family with three generations affected by an autosomal dominant centronuclear palsy. This gene is characterized by ptosis that begins in childhood and a slowly progressive weakness that starts in the second decade of life, involving face, neck and limbs. In this stage, muscle pan associated to exercise or cold muscle spasms may appear. The gene is expressed with differing intensity in each individual. Myopathic electromyographic alterations are only found in functionally impaired subjects. Muscle biopsy shows type I fiber atrophy and central nuclei in a high percentage of fibers, specially in type I fibers.
Asunto(s)
Parálisis/genética , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parálisis/patología , Linaje , FenotipoAsunto(s)
Dinoflagelados , Enfermedades Transmitidas por los Alimentos/mortalidad , Parálisis/mortalidad , Saxitoxina/envenenamiento , Intoxicación por Mariscos , Adulto , Animales , Autopsia , Chile , Femenino , Contaminación de Alimentos/análisis , Enfermedades Transmitidas por los Alimentos/etiología , Enfermedades Transmitidas por los Alimentos/patología , Humanos , Masculino , Parálisis/etiología , Parálisis/patologíaRESUMEN
The necropsy findings of ten subjects died as a consequence of paralytic shellfish intoxication are presented. These deaths occurred between march 1991 and january 1992, affected to seamen and occurred within 72 hours of contaminated shellfish ingestion. Necropsies were performed within 24 hours of death. The most outstanding necropsy findings were the presence of pink lividities, mydriasis and isocoria, airway obstruction with gastric contents, severe brain, lung liver and spleen swelling and edema, and digestive and respiratory mucosal congestion and friability. The toxicological study of urine, gastric content and organ samples revealed the presence of shellfish paralytic poison.
Asunto(s)
Parálisis/patología , Saxitoxina/envenenamiento , Intoxicación por Mariscos , Adolescente , Adulto , Anciano , Niño , Chile , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parálisis/etiología , Factores de TiempoRESUMEN
Se trata de un caso de paciente transferido del Hospital departamental del Norte S.F.P por fiebre, la que fué tratada sin éxito como fiebre tifoidea; días después se instaló una disminución de la fuerza proximal del brazo derecho, acompañado de dolor en la cintura escapular ipsilateral. Los exámenes auxiliares no demostraron la etiología de la fiebre. Se destacan los hallazgos en las enzimas séricas, la biopsia del músculo clínicamente más afectado, los potenciales evocados somatosensoriales de ambos nervios medianos. El cuadro clínico, la evidencia electromiográfica de lesión de la raíz C5 y el incremento de las gammaglobulinas en el proteinograma electroforético, sugerirían un fenómeno parainfeccioso con alteración en la inmunidad, que pudo haber desarrollado una alteración autoinmune. Se revisan las características clínicas, pronóstico y terapia de esta importante y poco frecuente entidad
Asunto(s)
Humanos , Adulto , Masculino , Plexo Braquial/patología , Atrofia Muscular/patología , Parálisis/patologíaAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Encefalopatías/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/patología , Encéfalo/patología , Encefalopatías/patología , Preescolar , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/patología , Demencia/diagnóstico , Demencia/patología , Femenino , Humanos , Espasticidad Muscular/diagnóstico , Espasticidad Muscular/patología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/patología , Parálisis/diagnóstico , Parálisis/patología , Médula Espinal/patologíaRESUMEN
Twenty-one cases of neuroparalytic accidents of rabies vaccination (with suckling mouse brain vaccine), 11 of them fatal, were observed, occurring predominantly in men; the mean age of the patients was 29 years. On the average, 13 doses of the vaccine were used. Only three patients received less than seven doses. The mean latent period was 14 days (range, 4 to 24 days). In 16 patients (76%), a Guillain-Barré syndrome occurred that was moderate in three, severe in seven, and fatal in six. Pathologically, this was shown to be a typical polyradiculoneuritis. Five patients had fatal involvement of the central nervous system. Three had an acute disseminated perivenous leukoencephalopathy, with concurrent rabies encephalitis in one case. One patient had a perivenous myeloradiculopathy and one a chronic encephalomyelopathy of six years' duration with demyelinating plaques in the periventricular white matter, cerebellum, and spinal cord. Since the reduction of postexposure rabies vaccination to seven doses, no new cases have been observed in Colombia.