RESUMO
INTRODUCTION: Paraneoplastic motor neuron disease are rare among patients with renal cell carcinoma. OBJECTIVE: Present the clinical and electrophysiological evolution of a patient with a motor neuron disease and hypernephrome. CASE REPORT: A 60 years old woman, affected only by high level pressure since 10 years ago. She noticed sudden palsy of the left leg and 10 months later an abdominal ultrasound showed a renal cell carcinoma, discovered without other symptoms than neurologic. After radical nephrectnomy, the patient was treated with recombinant interferon alpha 2b. The neurologic damage advanced and she has a flaccid weakness and muscle atrophy in the legs and brisk reflexes, also in wasted limbs. There is Babinski, fasciculations, light flaccid dysarthria and laryngospasm. Peripheral nerve conduction studies are within normal limits. The electromyogram show positive sharp waves in both legs and left hand. Recruitment patterns are decreased and there are fasciculations in the tongue, upper and lower limbs. The magnetic resonance of the brain and spinal cord is normal. There are not evidence of metastasis. The question of whether or not this is a paraneoplastic form of motor neuron disease remain unclear. CONCLUSION: This case suggest the need to consider a renal cell carcinoma in the course of a motor neuron disease.
Assuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Doença dos Neurônios Motores/complicações , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Eletromiografia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doença dos Neurônios Motores/diagnóstico por imagem , Doença dos Neurônios Motores/cirurgia , RadiografiaRESUMO
INTRODUCTION: The treatment selection in the carpal tunnel syndrome according to the damage of the median nerve is important and all of these have adverse effects. A good alternative without undesired reactions is irradiation of the carpal tunnel with not coherent light between 920 and 940 nm emitted by gallium arsenide diodes, resembling the physic and therapeutic laser effects. PATIENTS AND METHODS: Twenty-six female patients with idiopathic middle carpal tunnel syndrome were irradiated 15 minutes daily during three weeks. The median nerve motor and sensitive neuroconduction was studied before and immediately after the treatment. RESULTS: The abnormal neuroconduction variables (latency, amplitude and velocity conduction) did not modify when treatment concluded, in spite of all the patients reported disappearance of pain and numbness in damaged hands. CONCLUSIONS: Not coherent light does not change the fibers functional state explored by conventional neuroconductions techniques. It remains to know if this light produces fine fibers improvement.
Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/terapia , Lasers , Nervo Mediano/fisiologia , Fototerapia , Arsenicais/uso terapêutico , Síndrome do Túnel Carpal/patologia , Feminino , Gálio/uso terapêutico , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Condução Nervosa , Estudos Retrospectivos , Resultado do TratamentoRESUMO
To study the effect of general anesthesia with diazepam, fentanyl and nitric oxide, a common combination during the intraoperative recording of visual evoked potentials (VEP) in transsphenoidal surgery, we compared the amplitude and latency of VEP components before anesthesia and at four moments after induction during the first hour of elective breast surgery in 20 patients with no neurological deficits. The results for these patients (group I) before anesthesia and 15 min after induction were also compared to presurgical recordings for 19 patients with hypophysial tumors and histories visual field and acuity involvement (group II). Latency increased significantly as a result of anesthesia whereas amplitude was affected to a lesser degree. Changes in latency of the main positive component was after anesthesia was the only parameter that was significantly different for the two group studied, variation being greater in group II.