Esclerose múltipla: estudo clínico e patológico de um caso

Lancellotti, Carmen L. Penteado; Paslar, Eliana A. Luckner; D'Andretta Neto, Carlos; Atra, Mauro; Tilbery, Charles P.

doi:10.1590/S0004-282X1989000400012

Resumos

Apresentamos um caso com diagnóstico definido de esclerose múltipla confirmado pelos achados necroscópicos. Os aspectos anatomopatológicos nessa doença são bem conhecidos e têm sido referidos por vários autores. O objetivo desta apresentação é a divulgação do primeiro caso de esclerose múltipla autopsiado na Santa Casa de São Paulo, onde já foram realizadas cerca de 30500 autópsias. Os achados macro e microscópicos observados no sistema nervoso central, com placas de desmielinização em fases diferentes de aíividade, são características da doença. A detecção de imunoglobulinas nessas placas, pelo método de imuno-histoquímica, adicionou aos achados morfológicos a hipótese patogênica de uma doença imunologicamente mediada.

We present a case with diagnosis of multiple sclerosis done on clinical criteria and proved by autopsy. The morphological aspects of the lesions are well known and often related in the literature. Our objetive is to describe the first necropsy among 30500 done at Santa Casa de São Paulo in a patient with the disease. The morphological aspects in the CNS with the characteristic plaques in differents grades of activity and the detection of immunoglobulins in these plaques confirm the pathogenic hypothesis about a disease immunologically mediated.

Esclerose múltipla: estudo clínico e patológico de um caso

Multiple sclerosis: clinical and pathological study of one case

Carmen L. Penteado Lancellotti^I; Eliana A. Luckner Paslar^II; Carlos D'Andretta Neto^III; Mauro Atra^IV; Charles P. Tilbery^V

^IDisciplina de Neurologia (DN) e do Departamento de Patologia (DP) da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Professor Associado do DP

^IIDisciplina de Neurologia (DN) e do Departamento de Patologia (DP) da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Ex-Residente do DP

^IIIDisciplina de Neurologia (DN) e do Departamento de Patologia (DP) da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Professor Assistente do DP

^IVDisciplina de Neurologia (DN) e do Departamento de Patologia (DP) da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Ex-Residente da DN

^VDisciplina de Neurologia (DN) e do Departamento de Patologia (DP) da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Professor Associado da DN

RESUMO

Apresentamos um caso com diagnóstico definido de esclerose múltipla confirmado pelos achados necroscópicos. Os aspectos anatomopatológicos nessa doença são bem conhecidos e têm sido referidos por vários autores. O objetivo desta apresentação é a divulgação do primeiro caso de esclerose múltipla autopsiado na Santa Casa de São Paulo, onde já foram realizadas cerca de 30500 autópsias. Os achados macro e microscópicos observados no sistema nervoso central, com placas de desmielinização em fases diferentes de aíividade, são características da doença. A detecção de imunoglobulinas nessas placas, pelo método de imuno-histoquímica, adicionou aos achados morfológicos a hipótese patogênica de uma doença imunologicamente mediada.

SUMMARY

We present a case with diagnosis of multiple sclerosis done on clinical criteria and proved by autopsy. The morphological aspects of the lesions are well known and often related in the literature. Our objetive is to describe the first necropsy among 30500 done at Santa Casa de São Paulo in a patient with the disease. The morphological aspects in the CNS with the characteristic plaques in differents grades of activity and the detection of immunoglobulins in these plaques confirm the pathogenic hypothesis about a disease immunologically mediated.

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Dr. Charles Peter Tilbery - Praça Charles Miller 8 - 01234 São Paulo SP - Brasil.

1. Adams CWM - Pathology of multiple sclerosis: progression of the lesion. Br Med Bull 33: 15, 1977.
2. Adams JM, Imagawa DT - Measles antibodies in multiple sclerosis. Proc Soc Exp Biol Med 111: 562, 1962.
3. Adams RD, Kubrok CS - The morbid anatomy of the demyelinative diseases. Am J Med 12: 510, 1952.
4. Allen IV, Millar JHD, Hutchinson MJ - General diseases in 120 necropsy-proven cases of multiple sclerosis. Neuropath Appl Neurobiol 4: 279, 1978.
5. Brody JA, Server JL, Henson TE - Virus antibody titres in multiple sclerosis patients, siblings and controls. J Am Med Assoc 216: 1441, 1971.
6. Cendrowski W, Niedzielska K - Multiple sclerosis: etiologic and diagnostic significance of measles virus antibodies in the cerebrospinal fluid and serum. J Neurol Neurochir Psychiatr 114: 215, 1974.
7. Esiri MM - Multiple sclerosis: a quantitative and qualitative study of immunoglobulin-containing cells in the central nervous system. Neuropath Appl Neurobiol 6: 9, 1980.
8. Gilbert J.T, Sadler M - Unsuspected multiple sclerosis. Arch Neurol 40: 533, 1983.
9. Guseo A, Jellinger A - The significance of perivascular infiltrations in multiple sclerosis. J Neurol 211: 51, 1975.
10. Hallpike JP - Clinical aspects of multiple sclerosis. In Hallpike JF, Adams CWM, Tourteliotte WW (eds): Multiple Sclerosis. Chapman and Hall, London, 1983, pg 129.
11. Kurtze JF - The geographic distribution of multiple sclerosis: an update with special reference to Europe and the Mediterranean region. Acta Neurol Scand 62: 65, 1980.
12. Lancelotti CLP - Estudo anatomopatológico do sistema nervoso central no sarampo. Dissertação de Mestrado. Faculdade de Medicina, Universidade de São Paulo. São Paulo, 1982.
13. Lassman H, Wisniewski HM - Chronic relapsing experimental allergic encephalomyelitis: clinicopathological comparison with multiple sclerosis. Arch Neurol 36: 490, 1979.
14. Lumsden CE - The immunogenesis of the multiple sclerosis plaque. Brain Res 28: 365, 1971.
15. Mackay RP, Hirano A - Forms of benign multiple sclerosis: report of two clinically silent cases discovered at autopsy. Arch Neurol 17: 588, 1967.
16. McDonald WI - Multiple sclerosis: the present position. Acta Neurol Scand 68: 65, 1983.
17. McDonald WI, Halliday AM - Diagnosis and classification of multiple sclerosis. Br Med Bull 33: 4, 1977.
18. McFarlin, McFarland HF - Multiple sclerosis. N Engl J Med 307: 1183, 1982.
19. Miller HG, Stanton JB, Gibbons JL - Parainfectious encephalomyelitis and related syndromes. Quart J Med 25: 427, 1956.
20. Moravin M, Klutzow WF - Subclinical multiple sclerosis. J Neurol 213: 71, 1976.
21. Norrby E, Link H, Olsson JE - Comparison of measles virus antibody titers in cerebrospinal fluid and serum from patients with multiple sclerosis and from controls. Arch Neurol 30: 285, 1974.
22. Pathak S, Webb HE - Paramyxovirus-like inclusions in brain of patients with severe multiple sclerosis. Lancet 30: 311, 1976.
23. Porterfield JS - Multiple sclerosis. Br Med Bull 33: 1, 1977.
24. Poser CM, Paty DW, Scheimberg L, McDonald WI, Davis FA, Ebels GC, Johnson FP, Sibley WA, Silberberg DM. Tourtellotte WW - New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13: 227, 1983.
25. Prineas J - Paramyxovirus like tubules in multiple sclerosis biopsy material. Acta Neuropath 25: 281, 1972.
26. Prineas J, Raine, CS - Eletron microscopy and immunoperoxidase studies of early multiple sclerosis lesions. Neurology 26: 29, 1976.
27. Raine CS, Powers JM. Suzuki K - Acute multiple sclerosis: confirmation of paramyxovirus-like intranuclear inclusions. Arch Neurol 30: 39, 1974.
28. Riekkinen PJ, Rinne UK, Savolainen H. Palo J, Kovalo E, Arstila A - Studies on the pathogenesis of multiple sclerosis. Eur Neurol 5: 229, 1971.
29. Rose AS, Ellison GW, Meyers LW, Tourtellotte WW - Criteria for the clinical diagnosis of multiple sclerosis. Neurology 26: 20, 1976.
30. Ross CAC, Lemman JAR, Melville ID - Virus antibody levels in multiple sclerosis. Br Med J 26: 511, 1969.
31. Roytta M, Frey H, Riekkinen P, Rinne UK - Pathogenesis of multiple sclerosis. Eur Neurol 14: 209, 1976.
32. Schumacker GA, Bube G, Kibler RE, Kurland LT, Kurtze JF, McDowell F, Nagler B, Sibley WA, Tourtellotte WW, Willmon TL - Problems of experimental trials of therapy in multiple sclerosis: report by the panel on evaluation of experimental trials of therapy in multiple sclerosis. Ann NY Acad Sci 122: 552, 1965.
33. Simpson JF, Tourtellotte WW, Kokmen E, Parker JA, Itabashi HH - Fluorescent protein tracing in multiple sclerosis brain tissue. Arch Neurol 20: 373, 1969.
34. Tanaka R, Iwasaki Y, Koprowski H - Ultrastructural studies of perivascular cuffins cells in multiple sclerosis brain. Am J Path 81: 467, 1975.
35. Tanaka R, Santoli D, Koprowski H - Unusual intranuclear filaments in the circulating lymphocytes of patients with multiple sclerosis and optic neuritis. Am J Path 83: 245, 1976.
36. Thompson AJ, Brazil J, Hutchinson M, Feighery C - Three possible laboratory indexes of disease activity in multiple sclerosis. Neurology 37: 515, 1987.
37. Wisniewski HM - Immunopathology of demyelination in autoimmune disease and virus infection. Br Med Bull 33: 54, 1977.
38. Wisniewski HM, Bloom BR - Primary demyelination as a cell-mediated immune reaction. J Exp Med 141: 346, 1975.

Datas de Publicação

Publicação nesta coleção
03 Jun 2011
Data do Fascículo
Dez 1989

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

[1] 1. Adams CWM - Pathology of multiple sclerosis: progression of the lesion. Br Med Bull 33: 15, 1977.

[2] 2. Adams JM, Imagawa DT - Measles antibodies in multiple sclerosis. Proc Soc Exp Biol Med 111: 562, 1962.

[3] 3. Adams RD, Kubrok CS - The morbid anatomy of the demyelinative diseases. Am J Med 12: 510, 1952.

[4] 4. Allen IV, Millar JHD, Hutchinson MJ - General diseases in 120 necropsy-proven cases of multiple sclerosis. Neuropath Appl Neurobiol 4: 279, 1978.

[5] 5. Brody JA, Server JL, Henson TE - Virus antibody titres in multiple sclerosis patients, siblings and controls. J Am Med Assoc 216: 1441, 1971.

[6] 6. Cendrowski W, Niedzielska K - Multiple sclerosis: etiologic and diagnostic significance of measles virus antibodies in the cerebrospinal fluid and serum. J Neurol Neurochir Psychiatr 114: 215, 1974.

[7] 7. Esiri MM - Multiple sclerosis: a quantitative and qualitative study of immunoglobulin-containing cells in the central nervous system. Neuropath Appl Neurobiol 6: 9, 1980.

[8] 8. Gilbert J.T, Sadler M - Unsuspected multiple sclerosis. Arch Neurol 40: 533, 1983.

[9] 9. Guseo A, Jellinger A - The significance of perivascular infiltrations in multiple sclerosis. J Neurol 211: 51, 1975.

[10] 10. Hallpike JP - Clinical aspects of multiple sclerosis. In Hallpike JF, Adams CWM, Tourteliotte WW (eds): Multiple Sclerosis. Chapman and Hall, London, 1983, pg 129.

[11] 11. Kurtze JF - The geographic distribution of multiple sclerosis: an update with special reference to Europe and the Mediterranean region. Acta Neurol Scand 62: 65, 1980.

[12] 12. Lancelotti CLP - Estudo anatomopatológico do sistema nervoso central no sarampo. Dissertação de Mestrado. Faculdade de Medicina, Universidade de São Paulo. São Paulo, 1982.

[13] 13. Lassman H, Wisniewski HM - Chronic relapsing experimental allergic encephalomyelitis: clinicopathological comparison with multiple sclerosis. Arch Neurol 36: 490, 1979.

[14] 14. Lumsden CE - The immunogenesis of the multiple sclerosis plaque. Brain Res 28: 365, 1971.

[15] 15. Mackay RP, Hirano A - Forms of benign multiple sclerosis: report of two clinically silent cases discovered at autopsy. Arch Neurol 17: 588, 1967.

[16] 16. McDonald WI - Multiple sclerosis: the present position. Acta Neurol Scand 68: 65, 1983.

[17] 17. McDonald WI, Halliday AM - Diagnosis and classification of multiple sclerosis. Br Med Bull 33: 4, 1977.

[18] 18. McFarlin, McFarland HF - Multiple sclerosis. N Engl J Med 307: 1183, 1982.

[19] 19. Miller HG, Stanton JB, Gibbons JL - Parainfectious encephalomyelitis and related syndromes. Quart J Med 25: 427, 1956.

[20] 20. Moravin M, Klutzow WF - Subclinical multiple sclerosis. J Neurol 213: 71, 1976.

[21] 21. Norrby E, Link H, Olsson JE - Comparison of measles virus antibody titers in cerebrospinal fluid and serum from patients with multiple sclerosis and from controls. Arch Neurol 30: 285, 1974.

[22] 22. Pathak S, Webb HE - Paramyxovirus-like inclusions in brain of patients with severe multiple sclerosis. Lancet 30: 311, 1976.

[23] 23. Porterfield JS - Multiple sclerosis. Br Med Bull 33: 1, 1977.

[24] 24. Poser CM, Paty DW, Scheimberg L, McDonald WI, Davis FA, Ebels GC, Johnson FP, Sibley WA, Silberberg DM. Tourtellotte WW - New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13: 227, 1983.

[25] 25. Prineas J - Paramyxovirus like tubules in multiple sclerosis biopsy material. Acta Neuropath 25: 281, 1972.

[26] 26. Prineas J, Raine, CS - Eletron microscopy and immunoperoxidase studies of early multiple sclerosis lesions. Neurology 26: 29, 1976.

[27] 27. Raine CS, Powers JM. Suzuki K - Acute multiple sclerosis: confirmation of paramyxovirus-like intranuclear inclusions. Arch Neurol 30: 39, 1974.

[28] 28. Riekkinen PJ, Rinne UK, Savolainen H. Palo J, Kovalo E, Arstila A - Studies on the pathogenesis of multiple sclerosis. Eur Neurol 5: 229, 1971.

[29] 29. Rose AS, Ellison GW, Meyers LW, Tourtellotte WW - Criteria for the clinical diagnosis of multiple sclerosis. Neurology 26: 20, 1976.

[30] 30. Ross CAC, Lemman JAR, Melville ID - Virus antibody levels in multiple sclerosis. Br Med J 26: 511, 1969.

[31] 31. Roytta M, Frey H, Riekkinen P, Rinne UK - Pathogenesis of multiple sclerosis. Eur Neurol 14: 209, 1976.

[32] 32. Schumacker GA, Bube G, Kibler RE, Kurland LT, Kurtze JF, McDowell F, Nagler B, Sibley WA, Tourtellotte WW, Willmon TL - Problems of experimental trials of therapy in multiple sclerosis: report by the panel on evaluation of experimental trials of therapy in multiple sclerosis. Ann NY Acad Sci 122: 552, 1965.

[33] 33. Simpson JF, Tourtellotte WW, Kokmen E, Parker JA, Itabashi HH - Fluorescent protein tracing in multiple sclerosis brain tissue. Arch Neurol 20: 373, 1969.

[34] 34. Tanaka R, Iwasaki Y, Koprowski H - Ultrastructural studies of perivascular cuffins cells in multiple sclerosis brain. Am J Path 81: 467, 1975.

[35] 35. Tanaka R, Santoli D, Koprowski H - Unusual intranuclear filaments in the circulating lymphocytes of patients with multiple sclerosis and optic neuritis. Am J Path 83: 245, 1976.

[36] 36. Thompson AJ, Brazil J, Hutchinson M, Feighery C - Three possible laboratory indexes of disease activity in multiple sclerosis. Neurology 37: 515, 1987.

[37] 37. Wisniewski HM - Immunopathology of demyelination in autoimmune disease and virus infection. Br Med Bull 33: 54, 1977.

[38] 38. Wisniewski HM, Bloom BR - Primary demyelination as a cell-mediated immune reaction. J Exp Med 141: 346, 1975.