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Background: Nonambulatory flaccid tetraparesis can be the result of diseases of the peripheral nervous system and it is characterized by generalized lower motor neuron (LMN) signs, as weakness, tetraparesis/tetraplegia, decreased muscle tone and reflexes. The term polyneuropathy is used for dysfunction of multiple peripheral nerves. In Brazil, there are several etiologies for polyneuropathy in dogs, such as acute idiopathic polyradiculoneuritis, botulism and myasthenia gravis. Toxoplasma gondii is an uncommon cause of LMN diseases in dogs. The aim of this report was to describe a case of flaccid tetraplegia toxoplasmosis in an adult dog with a Toxoplasma gondii serology with a markedly elevated IgG titer of 1:4096. Case: A 4-year-old intact mongrel male dog, weighing 19.6 kg, was referred to the Veterinary Medical Teaching Hospital of the Universidade Estadual de Londrina (UEL) with a 5-day history of weakness that progressed to tetraparesis. Physical examination revealed no significant changes other than the dull and unkempt coat. Neurologic examination revealed severe tetraparesis that was worse in the pelvic limbs, with decreased muscle tone in all four limbs. Postural reactions and the interdigital reflex were absent in all four limbs, as was the patellar reflex, but pain perception was present. There were no clinical signs of dysfunction on examination of the cranial nerves. Laboratory tests were performed, and creatine kinase was elevated (819 U/L). Blood was drawn to look for antibodies to Toxoplasma gondii and Neospora caninum class IgG using the indirect immunofluorescence technique. The antibody titer for Toxoplasma gondii (IgG) was 1:4096. A chest radiograph was performed to look for megaesophagus, and a pulmonary pattern suggestive of mild diffuse pneumonia was observed. Treatment was performed with sulfamethoxazole and trimethoprim, and the dog's condition improved slightly. Discussion: Based on lower motor neuron findings, the neurologic lesion was localized in the nerve roots, peripheral nerves, neuromuscular junctions, or muscles. The most important diseases in the list of differential diagnoses were immune-mediated or infectious polyradiculoneuritis (toxoplasmosis, neosporosis), myasthenia gravis, toxic polyneuropathy (botulism, chronic organophosphate poisoning), and paraneoplastic polyneuropathy. Among these differential diagnoses, polyradiculoneuritis is one of the most common. It is an idiopathic inflammatory disease. Exposure to raccoon saliva (in the U.S.), vaccination, or infection have been proposed as precipitating causes, but the triggers of this disease remain unknown. Serology for neosporosis was negative, while IgG titers for toxoplasmosis were 1:4096. In a previous study, dogs with acute polyradiculoneuritis were more likely to have T. gondii IgG serum antibody titers than dogs without neurologic signs. Infection with the protozoa T. gondii and N. caninum can cause intense polyradiculoneuritis in dogs accompanied by myositis, especially in puppies. One treatment trial was based on the administration of sulfonamide-trimethoprim with pyrimethamine, whose efficacy in the treatment of toxoplasmosis in dogs has also been reported in the literature. Neurologic deficits improved slightly, and there is a possibility that certain signs may not disappear completely because of the permanent damage caused by inflammation of the nervous system, as observed in the present case. The case had the limitation that it was not possible to perform other laboratory tests to demonstrate histopathologically the presence of Toxoplasma gondii organisms in muscles or nerves. Recovery of normal function is less likely in protozoan polyradiculoneuritis than in noninfectious polyradiculoneuritis. Thus, in the present case, the main suspicion was polyradiculoneuritis secondary to toxoplasmosis. Although it is a rare condition, it is important to consider toxoplasmosis in dogs with LMN-type tetraparesis or tetraplegia.

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Resumen ANTECEDENTES: la encefalopatía de Wernicke se origina por el déficit de vitamina B1 y sus características sobresalientes son: triada de confusión, ataxia y oftalmoplejia. Cuando hay déficit de memoria o aprendizaje se denomina síndrome de Wernicke-Korsakoff. CASO CLÍNICO: se comunica el caso de una paciente en su primer embarazo, de 18 semanas de gestación, con varios ingresos al hospital por hiperemesis gravídica; acudió al servicio de Urgencias por un cuadro de pérdida progresiva de fuerza en las extremidades inferiores. A los cinco días del ingreso tuvo empeoramiento del estado general. A la exploración física se identificó nistagmus horizonto-rotatorio, bilateral, espontáneo, tetraparesia flácida de predominio proximal, con arreflexia global de predominio en EEII y pérdida de tono de los esfínteres. La paciente se encontraba confusa, desorientada y repetitiva en su discurso. Se inició tratamiento con tiamina parenteral, por sospecha de polineuropatía metabólica por déficit de tiamina; el nistagmus y el cuadro de confusión disminuyeron. Un mes más tarde se programó para tratamiento intensivo de rehabilitación. La evolución del embarazo trascurrió con normalidad y continuó en tratamiento con tiamina y antieméticos, con estabilidad y control del cuadro. CONCLUSIÓN: la encefalopatía de Wernicke es una padecimiento de frecuencia excepcional, pero de consecuencias muy graves; de ahí la importancia de tenerlo en mente en pacientes embarazadas susceptibles de padecerlo y poner en práctica las medidas de profilaxis adecuada que eviten su aparición y las secuelas.

Abstract BACKGROUND: Wernicke's encephalopathy, caused by vitamin B1 deficiency, is characterised by the triad of confusion, ataxia and ophthalmoplegia. If memory or learning deficits appear simultaneously, it is known as Wernicke-Korsakoff syndrome. CLINICAL CASE: We present the case of a primigravida in her 18th week of pregnancy who had been suffering from hyperemesis gravidarum. She came to the emergency unit because of progressive loss of strength in her lower limbs. Five days after her admission, a deterioration of her general condition was observed. The examination revealed bilateral spontaneous horizontal-rotatory nystagmus, flaccid tetraparesis with proximal predominance, global areflexia predominantly in the lower limbs and loss of sphincters tone. The patient was confused, disoriented and repetitive in her speech. Parenteral vitamin B1 was initiated as a metabolic polineuropathy due to thiamine insufficiency was suspected. As a result the symptoms of nystagmus and confusion subsided. Intensive physical therapy was programmed in a rehabilitation unit 1 month later. Pregnancy developed normally and she continued with thiamine and antiemetic therapy. CONCLUSIONS: Wernicke's encephalopathy is an infrequent pathology, but its consequences may be really serious. This is the reason why it is paramount to take into account this entity in pregnant women liable to develop it and to carry out adequate prophylaxis to prevent its appearance and development of posterior sequels.

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The involvement of the Peripheral Nervous System (PNS) occurs in a small proportion of patients with vasculitis. In our case report, the patient appears with a sensory-motor polyneuropathy, manifestation of a systemic vasculitis, which involved only the vasa nervorum.

El compromiso del Sistema Nervioso Periférico (SNP) ocurre en una pequeña proporción de pacientes afectados por vasculitis. En nuestro caso clínico, la paciente en cuestión debuta con una polineuropatía sensitivo-motora, manifestación de una vasculitis sistémica que comprometía sólo la vasa nervorum.

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The present article aims to describe a case of an atlanto-occipital luxation in a ca-nine, showing severe tetraparesis and cervical pain after an automobilist accident. Given the data obtained in the anamnesis and his findings of the clinical and neuro-logical exam, a traumatic neurological injury was suspected, which would possibly reach the cervical spinal cord and/or brainstem. After requesting the radiographic examination, unilateral luxation of the right atlantooccipital joint was found. Facing the absence of response to the clinical treatment, the open surgical reduction and internal joint stabilization was chosen. However, postoperatively immediately, the animal presented a dyspneic and cyanotic panorama when they were imposed with fluid and oxygen therapy. Despite every effort, the animal died two days after the occurrence of surgery.

No presente trabalho objetivou-se descrever um caso de luxação atlanto-occipital em um canino, apresentando tetraparesia grave e dor cervical após acidente auto-mobilístico. Diante dos dados da anamnese e dos achados do exame clínico geral e neurológico, suspeitou-se de uma lesão neurológica traumática, que possivelmente teria atingindo a medula espinhal cervical e/ou o tronco encefálico. Após solicitação de exame radiográfico foi constatada luxação unilateral da articulação atlanto-occipital direita. Diante da ausência de resposta ao tratamento clínico optou-se pela redução cirúrgica aberta e estabilização interna da articulação. Entretanto, no pós- operatório, imediatamente, o animal apresentou quadro dispneico e cianótico, quando foram instituídas a fluidoterapia e oxigênio-terapia. Apesar de todos os esforços empregados, o animal foi a óbito após 2 dias da ocorrência da cirurgia.

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No presente trabalho objetivou-se descrever um caso de luxação atlanto-occipital em um canino, apresentando tetraparesia grave e dor cervical após acidente auto- mobilístico. Diante dos dados da anamnese e dos achados do exame clínico geral e neurológico, suspeitou-se de uma lesão neurológica traumática, que possivelmente teria atingindo a medula espinhal cervical e/ou o tronco encefálico. Após solicitação de exame radiográfico foi constatada luxação unilateral da articulação atlanto- -occipital direita. Diante da ausência de resposta ao tratamento clínico optou-se pela redução cirúrgica aberta e estabilização interna da articulação. Entretanto, no pós-operatório, imediatamente, o animal apresentou quadro dispneico e cianótico, quando foram instituídas a fluidoterapia e oxigênio-terapia. Apesar de todos os esforços empregados, o animal foi a óbito após 2 dias da ocorrência da cirurgia.

The present article aims to describe a case of an atlanto-occipital luxation in a canine, showing severe tetraparesis and cervical pain after an automobilist accident. Given the data obtained in the anamnesis and his findings of the clinical and neurological exam, a traumatic neurological injury was suspected, which would possibly reach the cervical spinal cord and/or brainstem. After requesting the radiographic examination, unilateral luxation of the right atlantooccipital joint was found. Facing the absence of response to the clinical treatment, the open surgical reduction and internal joint stabilization was chosen. However, postoperatively immediately, the animal presented a dyspneic and cyanotic panorama when they were imposed with fluid and oxygen therapy. Despite every effort, the animal died two days after the occurrence of surgery.

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