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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.40 no.1 São Paulo Mar. 1982

http://dx.doi.org/10.1590/S0004-282X1982000100009 

Uveomeningencefalites: registro de dois casos

 

Uveomeningoencephalitic syndromes: report of two cases

 

 

Wilson Luiz SanvitoI; Charles Peter TilberyII; João C. B Arrison VillaresIII

IProf. Pleno. Departamento de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo
IIProf. Assistente. Departamento de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo
IIIEx-Residente. Departamento de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo

 

 


RESUMO

Após considerações a propósito das manifestações clínicas das uveomeningencefalites, são relatados dois casos com características clínicas ligeiramente diferentes. No caso 1 tratava-se da doença de Harada, tendo o paciente apresentado quadro meningítico agudo acompanhado de confusão mental. O exame do líquido cefalorraquidiano evidenciou um quadro inflamatório do tipo linfo-monocitário e o paciente evoluiu com distúrbios acentuados da memória e uveíte bilateral. Após alguns meses de evolução, a doença deixou como seqüelas uma síndrome de Korsakoff e ambliopia acentuada no olho esquerdo. No caso 2 tratava-se de doença de Behcet, tendo o paciente apresentado dois surtos de meningite do tipo linfomonocitário, lesões herpetiformes na genitalia e uveíte no olho direito que evoluiu para amaurose. São feitas considerações sobre os aspectos etiopatogênicos destas afecções e sobre o controvertido uso dos corticosteróides em seu tratamento.


SUMMARY

The uveomeningoencephalitic syndromes are inflamatory diseases, more prevalent in oriental patients, without sexual predilection and with mean age of 30 years. From the clinical point of view they affect the uvea, retina, meninges, the central nervous system and skin and in most cases the onset is followed by three phases: the meningoencephalitic phase, the acute ophthalmic phase and the dermatologic phase. These includes the Harada disease, the Vogt-Koyanagi disease, the Behcet disease and the idiopathic forms. The Vogt-Koyanagi syndrome is a chronic and severa bilateral exudative uveitis associated with whitening of the hair and eyelashes and varying signs of meningeal irritation, less frequent than in Harada's disease. The Harada syndrome is a posterior uveitis accompanied by signs of meningeal irritation, increased protein levels and pleocytosis of the cerebrospinal fluid. The Behcet disease is a relapsing illness, characterized by oral and genital aphtous ulcers and ocular inflamation. In many cases there are additional features; in 10 to 25 percent of the cases there are neurologic involvement, and any portion of the nervous system may be affected. The authors studied two cases of uveome-ningoencephalic syndrome, one case of Vogt-Koyanagi-Harada disease (case 1) and another of Behcet disease (case 2). The case 1 was a white Brazilian, forty-five year-old man, with a acute headache, mental confusion and signs of meningeal irritation. The cerebrospinal fluid was a inflamatory one, with increased lymphocytes and monocytes, and one month after the patient developed bilateral uveit. The patient complicated with amblyopia of the left eye and a Korsakoff syndrome. There was no correlation in the literature of the Korsakoff syndrome and the uveomeningoencephalitic syndrome. The case 2 was a white Brazilian, twenty-four year-old man, with two episodes of meningitis, genital recurrent aphtous ulcers and uveitis in the right eye, with latter blindness of this eye. Some considerations about the etiopathogenic aspects are done and about the controversial use of corticoids in the treatment of these syndromes.


 

 

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