Diagnóstico das neuropatias periféricas diagnósticos sindrômicos, topográficos e etiológicos: syndromic, topographic and etiological diagnoses

Marques Junior, Wilson; Herrera, Ronaldo Francisco; Trade, Emília Simão; Barreira, Amilton Antunes

doi:10.1590/S0004-282X1992000400006

Resumos

Por avaliação retrospectiva, discriminam-se no presente estudo os diagnósticos sindrômicos topográficos e etiológicos aos quais se conseguiu chegar em 209 casos de neuropatias periféricas. A anamnese e o exame clínico-neurológico foram fundamentais para a realização dos diagnósticos sindrômicos e topográficos. A eletromiografia teve papel relevante, particularmente no que se refere aos diagnósticos topográficos. Os diagnósticos etiológicos dependeram, adicionalmente, de outros exames complementares, dentre os quais se destacam: glicemia e curva glicêmica; avaliação nutricional; avaliação familiar; biópsias de nervo, pele, faringe e seio maxilar; teste qualitativo para a presença de porfirinas na urina; ácido delta-aminolevulínico e porfobilinogênio urinários; exames radiológicos. As polineuropatias mais frequentemente encontradas foram as: etílico-carenciais, diabéticas, inflamatórias desmielinizantes agudas e hereditárias. As síndromes do túnel do carpo, as lesões traumáticas do VII nervo craniano e as neuralgias do trigêmeo foram os diagnósticos mais frequentes entre os de mono-neuropatias. A hanseníase, as lesões traumáticas! do plexo braquial e a síndrome do desfiladeiro torácico predominaram entre as multineuropatias.

neuropatias periféricas; diagnósticos sindrômico; topográfico; etiológico

A retrospective study was conducted to identify the syndromic, topographic and etiological diagnoses made for a group of 209 patients with peripheral neuropathies. Anamnesis and clinical-neurological examination were of fundamental importance for the syndromic and topographic diagnoses. Electromyography played an important role, especially with respect to the topographic diagnoses. The etiological diagnoses depended on additional complementary tests such as: blood glucose levels and blood glucose tolerance test; nutritional evaluation; family evaluation; nerve, skin, pharynx and maxillary sinus biopsies; qualitative tests for the presence of porphyrins in urine; urinary levels of delta-aminolevulinic acid and porphobilinogen; and radiological examinations. The most frequently encountered polyneuropathies were those consequent to alcoholism or to diabetes, and those of the acute demyelinating inflammatory or hereditary type. Among the cases of mononeuropathy, the most frequently diagnosed conditions were carpal tunnel syndromes, traumatic injury to the VII cranial nerve, and trigeminal neuralgias. Leprosy, brachial plexus injury and thoracic outlet compression syndrome predominated among the multineuropathies.

peripheral neuropathies; syndromic; topographic; etiological diagnoses

Diagnóstico das neuropatias periféricas diagnósticos sindrômicos, topográficos e etiológicos

Diagnosis of peripheral neuropathies: syndromic, topographic and etiological diagnoses

Wilson Marques Junior^I; Ronaldo Francisco Herrera^I; Emília Simão Trade^II; Amilton Antunes Barreira^III

^IMédico Assistente. Departamento de Neuropsiquiatria e Psicologia Médica e Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e Hospital das Clínicas de Ribeirão Preto

^IIProfessor Assistente. Departamento de Neuropsiquiatria e Psicologia Médica e Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e Hospital das Clínicas de Ribeirão Preto

^IIIProfessor Associado. Departamento de Neuropsiquiatria e Psicologia Médica e Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e Hospital das Clínicas de Ribeirão Preto

RESUMO

Por avaliação retrospectiva, discriminam-se no presente estudo os diagnósticos sindrômicos topográficos e etiológicos aos quais se conseguiu chegar em 209 casos de neuropatias periféricas. A anamnese e o exame clínico-neurológico foram fundamentais para a realização dos diagnósticos sindrômicos e topográficos. A eletromiografia teve papel relevante, particularmente no que se refere aos diagnósticos topográficos. Os diagnósticos etiológicos dependeram, adicionalmente, de outros exames complementares, dentre os quais se destacam: glicemia e curva glicêmica; avaliação nutricional; avaliação familiar; biópsias de nervo, pele, faringe e seio maxilar; teste qualitativo para a presença de porfirinas na urina; ácido delta-aminolevulínico e porfobilinogênio urinários; exames radiológicos. As polineuropatias mais frequentemente encontradas foram as: etílico-carenciais, diabéticas, inflamatórias desmielinizantes agudas e hereditárias. As síndromes do túnel do carpo, as lesões traumáticas do VII nervo craniano e as neuralgias do trigêmeo foram os diagnósticos mais frequentes entre os de mono-neuropatias. A hanseníase, as lesões traumáticas! do plexo braquial e a síndrome do desfiladeiro torácico predominaram entre as multineuropatias.

Palavras-chave: neuropatias periféricas., diagnósticos sindrômico, topográfico, etiológico.

SUMMARY

A retrospective study was conducted to identify the syndromic, topographic and etiological diagnoses made for a group of 209 patients with peripheral neuropathies. Anamnesis and clinical-neurological examination were of fundamental importance for the syndromic and topographic diagnoses. Electromyography played an important role, especially with respect to the topographic diagnoses. The etiological diagnoses depended on additional complementary tests such as: blood glucose levels and blood glucose tolerance test; nutritional evaluation; family evaluation; nerve, skin, pharynx and maxillary sinus biopsies; qualitative tests for the presence of porphyrins in urine; urinary levels of delta-aminolevulinic acid and porphobilinogen; and radiological examinations. The most frequently encountered polyneuropathies were those consequent to alcoholism or to diabetes, and those of the acute demyelinating inflammatory or hereditary type. Among the cases of mononeuropathy, the most frequently diagnosed conditions were carpal tunnel syndromes, traumatic injury to the VII cranial nerve, and trigeminal neuralgias. Leprosy, brachial plexus injury and thoracic outlet compression syndrome predominated among the multineuropathies.

Key words: peripheral neuropathies, syndromic, topographic, etiological diagnoses.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Apoio: CNPq, Processo 501405/91.

Dr. Amilton Antunes Barreira Departamento de Neuropsiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, USP -14049 Ribeirão Preto SP - Brasil.

1. Adour KK, Bell DN, Hilsinger JR. Herpes simplex virus in idiopathic paralysis (Bell's palsy). JAMA 1975, 233:527-530.
2. Adour KK, Wisger J. Idiopathic facial paralysis (Bell's palsy): factors affecting severity and outcome in 446 patients. Neurology 1974, 24 :1112-1116.
3. Aimard G, Trovillas P, Fournier G, Devic M. Rémarques à propos d'une statistique hospitalière de 129 cas de neuropathies périphériques. Lyon Méd 1976, 235:295-302.
4. Arnason BGW. Acute inflamatory demyelinating polyradiculopathies. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds): Peripheral Neuropathy. Ed 2. Philadelphia: 1984, p 2050-2100.
5. Asbury AK. Diagnostic considerations in Guillain-Barré syndrome. Ann Neurol 1981, 9:1-5.
6. Asbury AK. Arnason BG, Karp HR, MacFarlin DE. Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978, 3:565-567.
7. Beghi E, Kurland LT, Mulder DW, Nicolosi A. Brachial plexus neuropathy in the population of Rochester, Minesota, 1970-1981. Ann Neurol 1985, 18:320-323.
8. Brown MJ, Asbury AK. Diabetic neuropathy. Ann Neurol 1984, 15 :2-12.
9. Bullock WE. Lepra (Mal de Hansen). In Wyngarden JB, Smith LH (eds.: Cecil. Tratado de Medicina Interna. Ed 16. Rio de Janeiro: Interamericana, 1984, p 1581-1586.
10. Cawthorne T, Wilson T. Indication for intratemporal facial nerve surgery. Arch Otolaryngol 1963, 78:429-434.
11. Claus D, Eggers R, Engelhardt A, Neundorfer B, Warecka K. Ethanol and polyneuropathy. Acta Neurol Scand 1985, 72:312-314.
12. Dyck PJ. Inherited neuronal degeneration and atrophy affecting peripheral motor, sensory and autonomic neurons. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy. Ed 2. Philadelphia: Saunders 1984, p 1600-1655.
13. Dyck PJ. Detection, characterization and staging of polyneuropathy assessed in diabetics. Muscle and Nerve 1988, 11:21-32.
14. Dyck PJ, Karnes J, O'Brien PC. Diagnosis staging and classification of diabetic neuropathy, and association with other complications. In Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D Jr (eds): Diabetic Neuropathy. Philadelphia: Saunders, 1987, p 36-44.
15. Dyck PJ, Oviatt KF, Lambert EH. Intensive evaluation of referred unclassified neuropathies yields improved diagnosis. Ann Neurol 1981, 10:222-226.
16. Fagius J. Chronic cryptogenic polyneuropathy. Acta Neurol Scand 1983, 67:173-180.
17. Fortes-Rego J. Paralisia Facial Periférica Isolada: Uma Condição Controversa. Edição do autor. Brasília, 1981.
18. Hanser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of Bell's palsy in the population of Rochester Minnesota. Mayo Clin Proc 1971, 46:254-258.
19. Kemppainen R, Juntunen J. Hillbom M. Drinking habits and peripheral alchoolic neuropathy. Acta Neurol Scand 1982. 65:11-18,
20. Kimura J. Eletrodiagnosis in Diseases of Nerve and Muscle. Philadelphia: 1983, p 489-508.
21. Kimura J. Machida M. Kimura A. Median neuropathies. In Brown WF, Bolton CG (eds) : Clinical Eletromyography. Stoneham: Butterworth, 1987, p 75-96.
22. Marques W Jr, Barreira AA. Diagnóstico das neuropatias periféricas: aspectos gerais da população em estudo. Arq Neuro-Psiquiat (São Paulo) 1992, 50 :433-440.
23. Marques W Jr. Barreira AA. Herrera RF. Diagnóstico das neuropatias periféricas: alguns fatores relevantes para a realização do diagnóstico. Arq Neuro-Psiquiat (São Paulo) 1992, 50:441-447.
24. Martínez y Martínez ME. Neuropatias diabéticas numa população brasileira. Dissertação de Mestrado. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto, 1986.
25. Matthews WB. Cryptogenic polyneuritis. Proc R Soc Med 1952, 45:667-669.
26. Mummenthaler M. Braquial plexus neuropathies. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy Ed 2. Philadelphia: Saunders 1984, p 1383-1393.
27. Organização Mundial de Saúde (OMS). Report of the Study Group on Peripheral Neuropathies. Technical report series 654. Publicado no Brasil por Laboratorios Sintofarma (São Paulo), 1980.
28 Osuntokun BO. Geographical patterns of neuropathy: Africa. Ind Asbury AK, Gilliatt RW. Peripheral Nerve Disorders: a Practical Approach. London: Butterworth, 1984, p 320-328.
29. Parry GJG. Mononeuropathy multiplex. Muscle and Nerve 1985 8 :493-498.
30. Raff M, Asbury AK. Ischemic mononeuropathy and mononeuropathy multiplex in diabetes mellitus. N Engl J Med 1968. 279 :17-22.
31. Sabin TD, Swift TR. Leprosy. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy. Ed 2. Philadelphia: Saunders, 1984.
32 Said G. Neuropathies metaboliques: Neuropathies diabétiques. Rev Neurol (Paris) 1985, 141:683-693.
33. Scarpalezos S, Lygidakis C, Papageorgiu C, Maliara S, Koukoulomatti AS, Koutras C. Neural and muscular manifestations of hyoithyreoidism. Neurology 1973, 29:140-144.
34. Schaumburg HH, Spencer PS. Thomas PK. Disorders of Peripheral Nerves. Ed 2. Philadelphia: 1983, p 209-215. ladelphia: 1963, p 209-215.
35. Selby G. Diseases of the fifth cranial nerve. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy. Ed 2. Philadelphia: Saunders, 1984, p 1224-1265.
36. Shields RW. Alchoolic polyneuropathy. Muscle and Nerve 1987, 8:183-187.
37. Stevens JC. Lumbosacral plexus lesions. In Dyck PJ, Tilomas PK, Lambert EH, Bunge R. Peripheral Neuropathy. Ed. 2. Philadelphia: Saunders, 1984, p 1425-1434.
38. Stewart JD, Aguayo AJ. Compression and entrapment neuropathies. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds): Peripheral Neuropathy. Ed 2. Philadelphia: Saunders, 1984, p 1435-1457.
38. Thomas PK, Eliasson SG. Diabetic neuropathy. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy Ed 2. Philadelphia: Saunders, 1984, p 1773-1810.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Dez 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adour KK, Bell DN, Hilsinger JR. Herpes simplex virus in idiopathic paralysis (Bell's palsy). JAMA 1975, 233:527-530.

[2] 2. Adour KK, Wisger J. Idiopathic facial paralysis (Bell's palsy): factors affecting severity and outcome in 446 patients. Neurology 1974, 24 :1112-1116.

[3] 3. Aimard G, Trovillas P, Fournier G, Devic M. Rémarques à propos d'une statistique hospitalière de 129 cas de neuropathies périphériques. Lyon Méd 1976, 235:295-302.

[4] 4. Arnason BGW. Acute inflamatory demyelinating polyradiculopathies. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds): Peripheral Neuropathy. Ed 2. Philadelphia: 1984, p 2050-2100.

[5] 5. Asbury AK. Diagnostic considerations in Guillain-Barré syndrome. Ann Neurol 1981, 9:1-5.

[6] 6. Asbury AK. Arnason BG, Karp HR, MacFarlin DE. Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978, 3:565-567.

[7] 7. Beghi E, Kurland LT, Mulder DW, Nicolosi A. Brachial plexus neuropathy in the population of Rochester, Minesota, 1970-1981. Ann Neurol 1985, 18:320-323.

[8] 8. Brown MJ, Asbury AK. Diabetic neuropathy. Ann Neurol 1984, 15 :2-12.

[9] 9. Bullock WE. Lepra (Mal de Hansen). In Wyngarden JB, Smith LH (eds.: Cecil. Tratado de Medicina Interna. Ed 16. Rio de Janeiro: Interamericana, 1984, p 1581-1586.

[10] 10. Cawthorne T, Wilson T. Indication for intratemporal facial nerve surgery. Arch Otolaryngol 1963, 78:429-434.

[11] 11. Claus D, Eggers R, Engelhardt A, Neundorfer B, Warecka K. Ethanol and polyneuropathy. Acta Neurol Scand 1985, 72:312-314.

[12] 12. Dyck PJ. Inherited neuronal degeneration and atrophy affecting peripheral motor, sensory and autonomic neurons. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy. Ed 2. Philadelphia: Saunders 1984, p 1600-1655.

[13] 13. Dyck PJ. Detection, characterization and staging of polyneuropathy assessed in diabetics. Muscle and Nerve 1988, 11:21-32.

[14] 14. Dyck PJ, Karnes J, O'Brien PC. Diagnosis staging and classification of diabetic neuropathy, and association with other complications. In Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D Jr (eds): Diabetic Neuropathy. Philadelphia: Saunders, 1987, p 36-44.

[15] 15. Dyck PJ, Oviatt KF, Lambert EH. Intensive evaluation of referred unclassified neuropathies yields improved diagnosis. Ann Neurol 1981, 10:222-226.

[16] 16. Fagius J. Chronic cryptogenic polyneuropathy. Acta Neurol Scand 1983, 67:173-180.

[17] 17. Fortes-Rego J. Paralisia Facial Periférica Isolada: Uma Condição Controversa. Edição do autor. Brasília, 1981.

[18] 18. Hanser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of Bell's palsy in the population of Rochester Minnesota. Mayo Clin Proc 1971, 46:254-258.

[19] 19. Kemppainen R, Juntunen J. Hillbom M. Drinking habits and peripheral alchoolic neuropathy. Acta Neurol Scand 1982. 65:11-18,

[20] 20. Kimura J. Eletrodiagnosis in Diseases of Nerve and Muscle. Philadelphia: 1983, p 489-508.

[21] 21. Kimura J. Machida M. Kimura A. Median neuropathies. In Brown WF, Bolton CG (eds) : Clinical Eletromyography. Stoneham: Butterworth, 1987, p 75-96.

[22] 22. Marques W Jr, Barreira AA. Diagnóstico das neuropatias periféricas: aspectos gerais da população em estudo. Arq Neuro-Psiquiat (São Paulo) 1992, 50 :433-440.

[23] 23. Marques W Jr. Barreira AA. Herrera RF. Diagnóstico das neuropatias periféricas: alguns fatores relevantes para a realização do diagnóstico. Arq Neuro-Psiquiat (São Paulo) 1992, 50:441-447.

[24] 24. Martínez y Martínez ME. Neuropatias diabéticas numa população brasileira. Dissertação de Mestrado. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto, 1986.

[25] 25. Matthews WB. Cryptogenic polyneuritis. Proc R Soc Med 1952, 45:667-669.

[26] 26. Mummenthaler M. Braquial plexus neuropathies. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy Ed 2. Philadelphia: Saunders 1984, p 1383-1393.

[27] 27. Organização Mundial de Saúde (OMS). Report of the Study Group on Peripheral Neuropathies. Technical report series 654. Publicado no Brasil por Laboratorios Sintofarma (São Paulo), 1980.

[28] 28 Osuntokun BO. Geographical patterns of neuropathy: Africa. Ind Asbury AK, Gilliatt RW. Peripheral Nerve Disorders: a Practical Approach. London: Butterworth, 1984, p 320-328.

[29] 29. Parry GJG. Mononeuropathy multiplex. Muscle and Nerve 1985 8 :493-498.

[30] 30. Raff M, Asbury AK. Ischemic mononeuropathy and mononeuropathy multiplex in diabetes mellitus. N Engl J Med 1968. 279 :17-22.

[31] 31. Sabin TD, Swift TR. Leprosy. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy. Ed 2. Philadelphia: Saunders, 1984.

[32] 32 Said G. Neuropathies metaboliques: Neuropathies diabétiques. Rev Neurol (Paris) 1985, 141:683-693.

[33] 33. Scarpalezos S, Lygidakis C, Papageorgiu C, Maliara S, Koukoulomatti AS, Koutras C. Neural and muscular manifestations of hyoithyreoidism. Neurology 1973, 29:140-144.

[34] 34. Schaumburg HH, Spencer PS. Thomas PK. Disorders of Peripheral Nerves. Ed 2. Philadelphia: 1983, p 209-215. ladelphia: 1963, p 209-215.

[35] 35. Selby G. Diseases of the fifth cranial nerve. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy. Ed 2. Philadelphia: Saunders, 1984, p 1224-1265.

[36] 36. Shields RW. Alchoolic polyneuropathy. Muscle and Nerve 1987, 8:183-187.

[37] 37. Stevens JC. Lumbosacral plexus lesions. In Dyck PJ, Tilomas PK, Lambert EH, Bunge R. Peripheral Neuropathy. Ed. 2. Philadelphia: Saunders, 1984, p 1425-1434.

[38] 38. Stewart JD, Aguayo AJ. Compression and entrapment neuropathies. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds): Peripheral Neuropathy. Ed 2. Philadelphia: Saunders, 1984, p 1435-1457.

[39] 38. Thomas PK, Eliasson SG. Diabetic neuropathy. In Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) : Peripheral Neuropathy Ed 2. Philadelphia: Saunders, 1984, p 1773-1810.