Scielo RSS <![CDATA[Arquivos de Neuro-Psiquiatria]]> vol. 25 num. 3 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Neurological aspects of Chagas disease</b>]]> Carlos Chagas related in more than two 200 cases, what he called "nervous forms" of trypanosomiasis, that is neurological manifestations from central origin (idiotism, infantilism, pseudo-bulbar paralysis, aphasia, cerebellar ataxia, atetosis, espostic or paralytic diplegia, disbasia). At that time Chagas expressed his concepts as follows: "In relation to the frequency of trypanosomiasis nervous forms we have performed many observations which allow us to state that this disease is the one which causes the largest number of organic affections of the central nervous system, in human pathology". We are plenty convinced by Chagas's statement. By experiments on animals of laboratory we have very often noticed a rather varied neurological symptomatology, being worth point out identical syndromes to those observed by Chagas. Our autopsy material non-rarely include chronic Chagas cases presenting a most varied symtomatology. Among them we have named only three cases of discerebral nanism, a rather rare affection in other parts of the world and relatively frequent in our material. The fact which we have demonstrated, i.e., a relatively great decreasing of number of nervous cells in the peripheral system could happen in the central nervous system as well. Provided that there are only two quantitative works on neuron number diminishing in the central nervous system in mice and rats we decline to go into further details about central neuropathies in man. We emphasized the necessity to perform researches on this field by means of intimate collaboration between clinicians and pathologists, as the only way to confirm on scientific basis all that was observed by the panoramic and genial vision of Carlos Chagas. <![CDATA[<b>Neurological aspects of Chagas' disease</b>: <b>central nervous system</b>]]> The lesions of the nervous system in the Trypanosomiasis Cruzi are quite frequent and are not only limited to the encephalo-spinal-axis. Actually, they are much more common in the peripheral representations of the autonomic nervous system, resulting in the so-called enteromegalies (mega-esophagus, megacolon, etc.) so frequent in Brazil. However, only the clinical manifestations due to the encephalic and spinal lesions have been included in the neurological aspects of Chagas' disease (as formerly contended for by Carlos Chagas). In the acute phase of the central nervous system infestation, the Trypanosoma cruzi,as leishmanias, is found in cellular elements of the neuroglia (microglia, astroglia) and may be isolated from the peripheral blood and cerebrospinal fluid (inoculation in sensitive animals). The corresponding clinical manifestations are the severe difuse meningo-encephalo-myelitis with a high degree of lethality and also signs of infection, hepatomegaly and splenomegaly. The infants from endemic areas are much more compromised. The clinical-pathologic as well as experimental confirmations on that acute phase of the disease are numerous and irrefutable. In the chronic phase of the disease, the neurological manifestations are not very clear. Early in 1909, Chagas, impressed with the great number of cases of infantile encephalopathy found in infested regions, imputed to the T. cruzithe etiology of such cases of encephalopathy and considered them as pertaining to a chronic phase of the disease. This has not been confirmed by other investigations, and even if the etiologic agent were the T. cruzithe clinical manifestations have no evolutive character and seem more sequelae than symptoms of a real chronic nervous phase. Even experimentally it has not been possible to demonstrate the presence of parasites in the nervous system of infested animals after clearing of the signs of the acute phase. In patients with chronic Chagas' disease with lesions in several organs and with nervous symptoms (especially mental disturbances) it has not been possible to get positive results from the complement fixation test (Machado-Guerreiro's reaction) when performed using cerebrospinal fluid, yet this test is positive in about 97% of the cases when blood is used instead. Recently, Köberle and coworkers have shown a great diminution in the number of nerve cells in the intramural plexuses of hollow viscera and in the cerebellum and spinal cord of men and experimental animals with Chagas' disease. It is hoped this approach using neuronal countings will in a near future show which are the true cases of chronic Chagas nervous disease. Regarding the embolic phenomena of Chagas heart disease, they do not have particular symptomatological aspects, except the high degree of mortality. Theoretically, cerebral thrombotic phenomena may also develop under the same etiology, but they have not been demonstrated through a pathological study. <![CDATA[<b>Cerebellar changes in patients with chronic chagasic cardiopathy</b>]]> Foram estudados 12 cerebelos de pacientes com cardiopatia crônica chagásica, 9 cerebelos de pacientes com cardiopatias não chagásicas (ambos os grupos constituídos de indivíduos falecidos em fase de insuficiência cardíaca congestiva) e dois cerebelos de indivíduos normais, falecidos acidentalmente. Nos pacientes chagásicos foi verificada redução numérica nas células de Purkinje, alterações de natureza regressiva nas células remanescentes, alterações das cestas peripurkinjeanas e mobilização microglial. Estas modificações foram também encontradas nos cerebelos dos cardiopatas não chagásicos. As alterações observadas foram interpretadas como resultantes da hypoxemia do sistema nervoso central devido à falência cardíaca.<hr/>The study of the cerebellums of 12 patients with chronic Chagas' disease (chronic chagasic cardiopathy) has shown numeric reduction of the Purkinje cells with regressive changes in the remaining ones, changes in the nervous fibers of the Purkinje's cells nests and microgial mobilization. The same alterations were found in the cerebellums of 9 patients with non chagasic cardiopathy but, like the chagasic ones, with congestive heart failure. Two cerebelleums of "normal" persons accidentally died were used as controls. The changes in the cerebellar parenchyma were considered as resulting from hypoxaemia of the central nervous system due to congestive heart failure. <![CDATA[<b>Quantitative study of Purkinje cells in the acute phase of experimental Chagas' disease</b>]]> O autor estudou quantitativamente as células de Purkinje em cortes semi-seriados do cerebelo de camundongos inoculados experimentalmente com T. cruzi,tendo verificado considerável destruição neuronal na fase aguda da enfermidade.<hr/>A quantitative study of Purkinje cells was done through semi-serial sections of cerebellum of mice experimentally innoculated by Trypanosoma cruzi. Avery marked neuronal destruction was found in the acute phase of Chagas' disease. <![CDATA[<b>Histochemical aspects of the myenteric plexus in experimental Chagas disease</b>]]> Foi comparada, na doença de Chagas experimental em ratos brancos, a atividade esterásica entre animais infectados e animais de um grupo controle. Do ponto de vista histológico ocorreram poucas alterações no plexo de Auerbach. Entretanto, a evidente diminuição da atividade esterásica parece demonstrar que os animais infectados perdem, mesmo antes da ocorrência de lesões histológicas, a citada atividade enzimática.<hr/>In experimental Chagas disease of white rats the esterase activity was compared between the infected and the control animals. Few histologic changes were found at the Auerbach plexus. The marked decrease of the esterase activity, however, seems to show that in the infected animals this activity decreases even before hystologic lesions are evident. <![CDATA[<b>Sweating in patients with chronic Chagas' disease</b>]]> Foi estudada a sudoração em pacientes com moléstia de Chagas crônica, mediante estímulo térmico (teste de Minor). As perdas hídricas dos pacientes chagásicos foram significativamente menores do que as dos pacientes não chagásicos.<hr/>The sweating in patients with chronic Chagas' disease by using thermic stimulus (Minor test) is studied. The loss of water was significantly lower in the patients with Chagas' disease when compared with the loss in non chagasic patients. <![CDATA[<b>Methysergide in the treatment of temporal lobe epilepsy</b>]]> A metisergide (butanolamida do ácido 1-metil-lisérgico) foi empregada experimentalmente em 78 pacientes com epilepsia psicomotora e com alterações focais (ondas "sharp") de projeção em um dos lobos temporais, no EEG. Foram usadas doses diárias de 2 a 6 mg, associadas a 0,1 g de fenobarbital. Dos 78 pacientes, 59 responderam de maneira favorável ao tratamento, sendo que 47 deixaram de sofrer crises e 12 apresentaram diminuição acentuada da freqüência e intensidade das crises. As manifestações psíquicas também melhoraram com o tratamento, ao contrário do que geralmente acontece com outras drogas. As alterações eletrencefalográficas desapareceram ou melhoraram em 64% dos pacientes. Reações secundárias ocorreram em 39 dos pacientes, na fase inicial do tratamento, e foram de curta duração, desaparecendo espontâneamente.<hr/>Methysergide (1-methyl-lysergic acid butanolamide) was used experimentally in 78 patients with psychomotor epilepsy and with focal abnormal activity (sharp waves) in one of the temporal lobes, in the EEG. The usual dosage of methysergide was 2 to 6 mg daily (only 36 patients received more than 2 mg daily) and every patient received fenobarbital 0.1 g daily also. Out of the 78 patients, 59 responded well to the treatment; 47 were free of seizures and in 12 there was decrease in frequency and severity of seizures. Psychic symptoms also decreased with the use of methysergide. The EEG was improved in 27 per cent of patients and became normal in 37 per cent, after twelve months of treatment. Slight side effects were reported by 39 pacients but they disappeared in a few days. <![CDATA[<b>Focused ultrasound</b>: <b>a new weapon for stereotaxic surgery</b>]]> O autor faz um apanhado das teorias fundamentais do ultrassom focalizado e seu uso em cirurgia estereotáxica cerebral. É feita análise comparativa entre as vantagens do ultrassom frente às demais técnicas de lesão estereotáxica e são considerados os dados de importância quanto ao tipo de apralehagem empregada e o modo de sua utilização. Como ilustração de suas possibilidades práticas, são referidas as aplicações deste tipo de irradiação no tratamento do parkinsonismo, de hipercinesias, da neuralgia do trigêmeo, de neuromas de amputação e da síndrome de Menière, na prática de comissurotomias e de lobotomias pré-frontais, na obtenção de lesões em trabalhos experimentais.<hr/>A brief analysis of the theories and applications of focused ultrasound in stereotaxic surgery is presented. A comparative analysis is made regarding the advantages of the use of focused ultrasound in relation to other stereotaxic techniques. Equipment and its utilization is also considered. The possibilities for the use of this type of irradiation in the treatment of hyperkinesias, commissurotomies, neuromas, lobotomies, tic douloureux, Menière's syndrome and in laboratory experiments are also mentioned.