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The Brown-Vialetto-Van Laere syndrome or the riboflavin transporter deficiency syndrome is a neurodegenerative disorder initially reported by Brown in 1894, by Vialetto in 1936, and by Van Laere in 1966. The syndrome has been described in more than 100 patients since then. Hearing loss is the most common symptom of the syndrome, as most individuals have it through the development of the disease. Although there is a variation between the onset of hearing loss and the other possible symptoms, hearing loss usually begins in early childhood. Nevertheless, there are some cases describing hearing loss starting in adults. Hereby, we present a case report of a patient who started having the symptoms at the age of 14 and who had a mutation in the SLC52A3 gene, presenting with sensorineural hearing loss associated with cerebellar ataxia, who also underwent successful cochlear implant surgery.

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Oral phase swallowing impairment in motor neuron disease (MND) is caused by tongue weakness, fasciculation and atrophy, which may compromise oral transit time and total feeding time. OBJECTIVE To describe and correlate total oral transit time (TOTT) with functional performance in MND using different food consistencies. METHODS The study was conducted on 20 patients with MND, regardless of type or duration of the disease, of whom nine were excluded due to issues on the videofluoroscopic swallowing images. The remaining 11 patients (nine men and two women) ranged from 31 to 87 years of age (mean: 57 years) with scores on the Penetration Aspiration Scale ranging from ≤ 2 to ≤ 4. The Amyotrophic Lateral Sclerosis Functional Rating Scale - revised questionnaire was applied to classify individuals according to global, bulbar and bulbar/respiratory parameters. Videofluoroscopy of swallowing using 5ml of different consistencies was performed and a quantitative temporal analysis of the TOTT was carried out with the aid of specific software. RESULTS There was a wide variation in the TOTT within the same food consistency among MND patients. There was a correlation between the TOTT and overall functional performance for the thickened liquid consistency (r = -0.691) and between the TOTT and bulbar performance for the pureed consistency (r = -0.859). CONCLUSION Total oral transit time in MND varies within the same food consistency and the longer the TOTT, regardless of food consistency, the lower the functional performance in MND.

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ABSTRACT Oral phase swallowing impairment in motor neuron disease (MND) is caused by tongue weakness, fasciculation and atrophy, which may compromise oral transit time and total feeding time. Objective: To describe and correlate total oral transit time (TOTT) with functional performance in MND using different food consistencies. Methods: The study was conducted on 20 patients with MND, regardless of type or duration of the disease, of whom nine were excluded due to issues on the videofluoroscopic swallowing images. The remaining 11 patients (nine men and two women) ranged from 31 to 87 years of age (mean: 57 years) with scores on the Penetration Aspiration Scale ranging from ≤ 2 to ≤ 4. The Amyotrophic Lateral Sclerosis Functional Rating Scale - revised questionnaire was applied to classify individuals according to global, bulbar and bulbar/respiratory parameters. Videofluoroscopy of swallowing using 5ml of different consistencies was performed and a quantitative temporal analysis of the TOTT was carried out with the aid of specific software. Results: There was a wide variation in the TOTT within the same food consistency among MND patients. There was a correlation between the TOTT and overall functional performance for the thickened liquid consistency (r = −0.691) and between the TOTT and bulbar performance for the pureed consistency (r = −0.859). Conclusion: Total oral transit time in MND varies within the same food consistency and the longer the TOTT, regardless of food consistency, the lower the functional performance in MND.

RESUMO O comprometimento na fase oral da deglutição na doença do neurônio motor (DNM) é ocasionado por fraqueza, fasciculação e atrofia de língua, podendo comprometer o tempo de trânsito oral (TTO) e o tempo total de alimentação. Objetivo: Descrever e relacionar o tempo de trânsito oral total (TTOT) com o desempenho funcional na DNM em distintas consistências de alimento. Métodos: Participaram 20 indivíduos com DNM, independente do tipo ou tempo de doença. Foram incluídos 11 indivíduos, nove homens e duas mulheres, faixa etária de 31 a 87 anos (média de idade de 57 anos) e com Penetration Aspiration Scale (Rosenbek et al., 1996) de ≤ 2 a ≤ 4. Foram excluídos nove indivíduos por questões técnicas relacionadas às imagens videofluoroscópicas de deglutição. Aplicado o questionário Amyotrophic Lateral Sclerosis Functional Rating Scale - revised para classificação dos indivíduos de acordo com parâmetros Global, Bulbar e Bulbar/Respiratório. Realizada videofluoroscopia da deglutição com diferentes consistências de alimento no volume de cinco ml e análise quantitativa do TTOT por meio de software específico. Resultados: Houve ampla variação no TTOT dentro da mesma consistência de alimento na DNM. Houve correlação entre o TTOT e o desempenho funcional global na consistência líquida espessada (r = −0,691) e para o TTOT e o desempenho bulbar na pastosa (r = −0,859). Conclusão: O tempo de trânsito oral total na DNM varia dentro da mesma consistência de alimento e quanto mais longo o TTOT, independente da consistência do alimento, menor foi o desempenho funcional na DNM.

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Brown-Vialetto-Van Laere syndrome (BVVLS) is a rare neurological disease characterized by sensorineural hearing loss and multiple cranial nerve palsies, usually involving the VIIth and IXth to XIIth cranial nerves. We describe the clinical and pathological features of a 33-year-old woman with BVVLS. The patient developed progressive exertional dyspnea, with clinical and laboratory findings of right-sided heart failure and pulmonary hypertension. She developed status epilepticus in the setting of cardiac deterioration and respiratory infection, and died of cardiogenic and septic shock. Autopsy disclosed bilateral neuronal loss and gliosis in the inferior colliculi, locus coeruleus and facial and vestibular nuclei. Cor pulmonale is a complication of hypoventilation-induced hypoxia and hypercapnia and had not yet been reported in BVVLS.

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INTRODUCTION: Diagnosis of amyotrophic lateral sclerosis (ALS) requires of the exclusion of several pathologies of the cranio cervical junction that mimic ALS. The importance of such exclusion is in fact sustained by the prognostic implications that ALS has. CASE REPORT: We report the case of a 58-year-old woman with bulbar onset sporadic ALS associated with Chiari type I malformation on the MRI of the craniocervical junction. At the time of consultation, ALS was clinically defined but some of the symptoms were contributed by cerebellar amygdala compression of the medulla. CONCLUSION: To our knowledge this is the first time were both diseases are reported symptomatic on the same patient, and despite its rarity, it is important to be aware of this possible association for the diagnostic, therapeutic and prognostic implications it has.

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Brown-Vialetto-van Laere syndrome is a rare hereditary or sporadic degenerative disorder characterised by progressive sensoryneural deafness, followed or accompanied by cranial nerve palsies. The anterior horn cells and the optic pathways may be involved in some cases. We report two cases, and comment the differential diagnosis and the relationships of this syndrome to the muscle spinal atrophies and the hereditary deafness.

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A síndrome de Brown-Vialleto-van Laere é entidade degenerativa hereditária ou esporádica, rara, caracterizada por surdez neuro-sensorial seguida ou acompanhada por uma variedade de alteraçoes de nervos cranianos, podendo ainda ocorrer acometimento de corno anterior e vias ópticas. Relatamos dois casos de discutimos o diagnóstico diferencial da síndrome com as atrofias espinhais e surdez hereditária.

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A case of chronic bulb-pontine paralysis with deafness, with early onset, coursing along nine years is reported. There seem to be histopathologic and electromyographic evidences on which is concluded to be a variant form of juvenile amyotrophic lateral sclerosis (Van Laere form).

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Examination of the speech mechanism (the vocal tract) frequently provides information about certain neurologic lesions. The speech, swallowing and respiratory patterns of patients with cerebellar, upper motor neuron, lower motor neuron and extra-pyramidal lesions (parkinsonism) were studied, 10 of each category. The patient's lingual, labial and velar movement was examined cineradiographically during production of four short speech samples and the oral, through esophageal structures, during chewing and swallowing. Videotape, with simultaneous voice recording, and 16 mm. film were used. Oral, pharyngeal and esophageal transit times during swallowing were determined. These quantified tests reveal distinctive differences in vocal tract physiology between patient groups. The specific physiologic patterns characteristic of each neurological lesion were discussed and illustrated with films. Each patient group in this study exhibited a distinctive profile distinguishing it from every other. The results also indicate that if only a portion of these studies was completed, the disorder might be erroneously classified. The findings emphasize the need for complete and detailed physiologic studies of the speech and swallowing of patients with neurologic lesions, as an aid to accurate diagnosis.

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