RESUMO
A thirty three year-old, male patient was admitted at the Hospital of the São Paulo University School of Medicine, at the city of São Paulo, Brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. Blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-HIV and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis B virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes.
Assuntos
Hepatite B/complicações , Mononeuropatias/complicações , Doença Aguda , Adulto , Humanos , Masculino , Mononeuropatias/patologiaRESUMO
The distribution and relative intrafascicular contribution of myelin fibers derived from spinal segments L-4 to L-6 were analyzed in adult rat sciatic nerve and its main branches, using 200-kDa neurofilament subunit immunodetection in previously injured nerve sections in the L-4 or L-5 spinal branch or both. These branches' functional contribution was evaluated 16 days after the injury, using the method of J. Bain, S. Mackinnon, and D. Hunter (1988, Plast. Reconstr. Surg. 83: 129-136). A common topographic intrafascicular distribution was found in 69% of cases, with notable segregation of L-4 and L-5 fibers and a random distribution for L-6 fibers. At sciatic nerve main branch level, L-4 contributes almost entirely to the peroneal nerve, L-5 to the tibial nerve, and L-6 and other branches to the sural nerve. After injury to L-4, a significant reduction in peroneal nerve functional index (PFI) was observed, as was a reduction in print length (PL). Injury to L-5 caused a significant reduction in the sciatic (SFI) and tibial (TFI) functional nerve indices, an increase in PL, and a reduction in the spread between opposite toes (TS). Finally, transection of both L-4 and L-5 was followed by a significant reduction in all functional indices measured, an increase in PL, and a reduction in intermediate toe (ITS) and opposite toe spread (TS). The results indicate a direct relationship between the distribution and contribution of the spinal nerve fibers forming the sciatic nerve and the alteration in functional indices for sciatic, tibial, and peroneal nerves.
Assuntos
Mononeuropatias/fisiopatologia , Fibras Nervosas Mielinizadas , Nervo Isquiático/fisiopatologia , Nervos Espinhais/fisiopatologia , Animais , Feminino , Imuno-Histoquímica , Região Lombossacral , Masculino , Mononeuropatias/patologia , Fibras Nervosas Mielinizadas/patologia , Proteínas de Neurofilamentos/metabolismo , Nervo Fibular/patologia , Nervo Fibular/fisiopatologia , Ratos , Ratos Wistar , Nervo Isquiático/patologia , Nervos Espinhais/patologia , Nervo Tibial/patologia , Nervo Tibial/fisiopatologia , Degeneração Walleriana/metabolismo , Degeneração Walleriana/patologiaRESUMO
The neurologic involvement during Wegener granulomatosis reaches 15-50% of patients, however as initial symptomatology is not commented in the literature. We describe a patient with Wegener's granulomatosis and mononeuritis multiplex, emphasizing the fact that neurologic manifestations anticipated systemic symptoms, and also focusing on the diagnostic contribution of sural biopsy and the good outcome of neurologic disease.
Assuntos
Granulomatose com Poliangiite/complicações , Mononeuropatias/etiologia , Idoso , Feminino , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/patologia , Humanos , Mononeuropatias/diagnóstico , Mononeuropatias/patologia , Nervo Sural/patologiaRESUMO
O acometimento neurológico no curso da granulomatose de Wegener atinge 15-50 por cento dos pacientes, porém como sintomatologia inicial näo é comentado na literatura. Relatamos o caso de uma paciente com mononeurite múltipla secundária a granulomatose de Wegener, enfocando os aspectos de antecipaçäo do quadro neurológico em relaçäo aos sintomas sistêmicos, a contribuiçäo diagnóstica da biópsia do nervo sural e a boa evoluçäo do quadro neurológico