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Neurosindrome minimo en la tripanosomiasis cruzi crónica: (Estudio de dos casos de encefalopatia chagástica crónica)

The clinical and anatomophathological study of two cases of chronic encephalopaty due to Trypanosoma cruzi is exposed. Only initial symptom in both cases was severe, continous, headache. Progressively other symptoms, denouncing compromise of the central nervous system, appeared, integrating slowly a full picture of cerebral disease, in the first case with diffuse cortical symptomatology, in the second case with pseudotumoral syndrome. In both cases, signs of trypanosomic cardiopathy were presented, but in none of both, the prevalent characteristic elements assigned to Chagas Disease pancarditis were evident. Histopathologic study of the brains (first case died in a road accident, second case finished in encephalopathic coma, possibly aggravated by hypermedication) showed in both cases a microfocal cortico-meningoencephalitis, extensive but superficial; many of the nodules being concentric to alterated blood vessels (primary vasculitis?). In the second case, aside from the true encephalitic lesions, arteriolar thrombotic alterations (due to emboly of mural thrombi generated in the usual apical pancarditic lesions of Chagas Disease) were found. Irregular zones of demielinization, neuronolisis and satellitosis (neurophagia) were present too. In the second case, scarse leishmanioids of T. cruzi were found in typical foci of inflammatory necrotizing lesions. As in both cases, a continous and persistent headache was the only initial symptom, it is believed that former clinical observations of junior author are confirmed, allowing to cosnider headache (in concomitancy with positive serologic complement deviation reaction for T. cruzi) as a minimal neurosyndrome of trypanosomiasis cruzi. Pathogenic mechanisms, symptoms and evolution of the chronic encephalopathy found in those two cases are discussed, on base of former knowledge of neural forms of trypanosomiasis cruzi.


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