Meningoencefalite linfocitária difusa aguda: relato de um caso clínico-patológico

Pittella, José Eymard Homem; Brasileiro Filho, Geraldo; Ottoni, Carlos Milton Coutinho

doi:10.1590/S0004-282X1986000300009

Resumos

É descrito um caso autopsiado de meningoencefalite linfocitária difusa aguda numa criança de 8 anos de idade. O quadro clínico teve início 7 dias antes do óbito e foi caracterizado por febre e cefaléia occipital seguidos por piora do estado geral, vômitos e crise convulsiva generalizada com parada cárdio-respiratória e coma. O estudo anatomopatológico mostrou alterações apenas no encéfalo, onde se evidenciou edema cerebral intenso e infiltrado inflamatorio predominantemente linfocitário, perivascular, particularmente na substância branca, em todas as regiões examinadas. Este caso é comparado a outros semelhantes registrados na literatura e discute-se a etiopatogênese da meningoencefalite linfocitária difusa aguda. Destaca-se a necessidade de relatar os casos de encefalite aguda não-bacteriana pelo fato de que a maioria deles permanece com a etiologia indeterminada.

A clinicopathologic case of acute diffuse lymphocytic meningoencephalitis in a 8-year-old child is reported. Clinicai picture started 7 days prior to death and was characterized by fever and occipital cephalea followed by worsening of general conditions, vomiting and generalized convulsive crisis together with cardiopulmonary arrest and coma. The pathologic examination showed alterations only in the brain, namely pronounced cerebral edema and inflammatory infiltrate, predominantly lymphocytic, perivascular, particularly in the white matter, in all regions analyzed. This case is compared to the ones described in the literature and the etiopathogenesis of acute diffuse lymphocytic meningoencephalitis is discussed. The necessity of making public cases of non-bacterial acute encephalitis is emphasized, due to the fact that most of them remain with indetermined etiology.

Meningoencefalite linfocitária difusa aguda: relato de um caso clínico-patológico

Acute diffuse lymphocytic meningoencephalitis: a clinicopathologic report

José Eymard Homem Pittella^I; Geraldo Brasileiro Filho^I; Carlos Milton Coutinho Ottoni^II

^IProfessor Adjunto - Laboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal e Departamento de Pediatria da Faculdade de Medicina da Universidade Federal de Minas Gerais (FMUFMG)

^IIProfessor Auxiliar - Laboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal e Departamento de Pediatria da Faculdade de Medicina da Universidade Federal de Minas Gerais (FMUFMG)

RESUMO

É descrito um caso autopsiado de meningoencefalite linfocitária difusa aguda numa criança de 8 anos de idade. O quadro clínico teve início 7 dias antes do óbito e foi caracterizado por febre e cefaléia occipital seguidos por piora do estado geral, vômitos e crise convulsiva generalizada com parada cárdio-respiratória e coma. O estudo anatomopatológico mostrou alterações apenas no encéfalo, onde se evidenciou edema cerebral intenso e infiltrado inflamatorio predominantemente linfocitário, perivascular, particularmente na substância branca, em todas as regiões examinadas. Este caso é comparado a outros semelhantes registrados na literatura e discute-se a etiopatogênese da meningoencefalite linfocitária difusa aguda. Destaca-se a necessidade de relatar os casos de encefalite aguda não-bacteriana pelo fato de que a maioria deles permanece com a etiologia indeterminada.

SUMMARY

A clinicopathologic case of acute diffuse lymphocytic meningoencephalitis in a 8-year-old child is reported. Clinicai picture started 7 days prior to death and was characterized by fever and occipital cephalea followed by worsening of general conditions, vomiting and generalized convulsive crisis together with cardiopulmonary arrest and coma. The pathologic examination showed alterations only in the brain, namely pronounced cerebral edema and inflammatory infiltrate, predominantly lymphocytic, perivascular, particularly in the white matter, in all regions analyzed. This case is compared to the ones described in the literature and the etiopathogenesis of acute diffuse lymphocytic meningoencephalitis is discussed. The necessity of making public cases of non-bacterial acute encephalitis is emphasized, due to the fact that most of them remain with indetermined etiology.

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Laboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal - Faculdade de Medicina, Universidade Federal de Minas Gerais - Av. Alfredo Balena, 190 - 30000 - Belo Horizonte, MG - Brasil.

1. ALBRECHTSEN, R. - The incidence of the so-called acute selective necrosis of granular layer of cerebellum in 1000 autopsied patients. Acta pathol. microbiol scand. Sect. A 85:193, 1977.
2. ALLEN, I.V. - Demyelinating diseases. In: J. Hume Adams, J.A.N. Corsellis & Li.W. Duchen (eds.): Greenfield's Neuropathology. Ed. 4. Edward Arnold Ltd., London, 1984, pg. 341.
3. van BOGAERT, L. - Post-infectious encephalomyelitis and multiple sclerosis: the significance of perivenous encephalomyelitis. J. Neuropathol. exp. Neurol. 9:219, 1950.
4. van BOGAERT, L. - Klinik der Meningoencephalitiden unbekannter Ursache (sog. Virus-Meningoencephalitiden) in Westeuropa. Nervenarzt 27:204, 1956.
5. van BOGAERT, L. - Some observations and reservations on the clinico-anatomical classification of the known encephalitides. In: L. van Bogaert, J. Radermecker, J. Hozay & A. Lowenthal (eds.): Encephalitides. Elsevier, Amsterdam, 1961, pg. 693.
6. van BOGAERT, L. - Leucoencephalitides and panencephalitides: closing remarks. In: L. van Bogaert, J. Radermecker, J. Hozay & A. Lowenthal (eds.): Encephalitides. Elsevier, Amsterdam, 1961, pg. 706.
7. BROWNELL. B. & TOMLINSON, A.H. - Virus disease of the central nervous system. In: J. Hume Adams, J.A.N. Corsellis & L.W. Duchen (eds.): Greenfield's Neuropathology. Ed. 4. Edward Arnold Ltd., London, 1984, pg. 272.
8. DONAT, J.F.; RHODES, K.H.; GROOVER., R.V. & SMITH, T.F. - Etiology and outcome in 42 children with acute nonbacterial meningoencephalitis. Mayo Clin. Proc. 55:156, 1980.
9. von ECÓNOMO, C. - Grippe-Enzephalitis und Encephalitis lethargica. Wien, klin. Wochenschr. 32:393, 1919.
10. GREENFIELD, J.G. - Encephalitis and encephalomyelitis in England and Wales during the last decade. Brain 73:141, 1950.
11. HART, M.N. & EARLE, K.M. - Hemorrhagic and perivenous encephalitis: a clinical-pathological review of 38 cases. J. Neurol. Neurosurs. Psychiat. 38:585, 1975.
12. IIZUKA, R. - Beitrag zur akuten diffusen lymphocytären Meningoencephalitis und Encephalopathie: Klinik und Neuropathologie einer nicht spezifischen Reaktionsform des zentralen Nervensystems. Arch. Psychiatr. Z. ges. Neurol. 206:705, 1965.
13. JACOB, H. - Zur klinisch-neuropathologischen Differentialdiagnose zwischen parainfektiösen (und postvaccinalen) Encephalitiden und akuten sporadischen Panleukoencephalitiden. Arch. Psychiatr. Z. ges. Neurol 197:507, 1958.
14. JACOB H. - Neuropathologie der Viruserkrankungen des Zentralnervensystems Dtsch. Z. Nervenheilkd. 182:472, 1961.
15. JELLINGER, K. & SEITELBERGER, F. - «Enzephalitis» bei Grippe. Wien, med Wochenschr. 109:201, 1959.
16. KOSKINIEMI, M.; MANNINEN, V.; VAHERI, A.; SAINIO, K.; EISTOLA, P. & KARLI, P. - Acute encephalitis: a survey of epidemiological, clinical and microbiological features covering a twelve-year period. Acta. med. scand. 209:115, 1981.
17. MANZ, H.J. - Pathology and pathogenesis of viral infections of the central nervous system. Hum. Pathol. 8:3, 1977.
18. MINAUF, M. & TATEISHI, J. - Beitrag zur «lymphocytären Encephalomeningitis». Arch. Psychiatr. Z. ges. Neurol. 209:307, 1967.
19. NATHANSON, N. & COLE, G.A. - Immunosuppression and experimental virus infection of the nervous system. Adv. Virus Res. 16:397, 1970.
20. PETERS, G. - Klinische Neuropathologie. Spezielle Pathologie der Krankheiten des zentralen und peripheren Nervensystems. Ed. 2. Georg Thieme Verlag, Stuttgart, 1970, S. 57.
21. RADERMECKER, J.; GUAZZI, G.C. & HOZAY, J. - A case of diffuse meningoencephalitis of the lymphocytic type affecting mainly the gray matter. In: L. van Bogaert, J. Radermecker, J. Hozay & A. Lowenthal (eds.): Encephalitides. Elsevier, Amsterdam, 1961, pg. 610.
22. SEITELBERGER, F. & ZISCHINSKY, H. - Rubeolen-Enzepahlitis. MMW 36:1681, 1962.
23. SRIVASTAVA, J.R. & BRIJENDRA, K.G. - Encephalitis in children: a clinical study of 409 cases. Indian J. Pediatr. 36:156, 1969.
24. WEBER, W. & ULRICH, J. - Multiple sclerosis, diffuse lymphoplasmocytic encephalitis and Alzheimer's disease in a patient with progressive dementia. Eur. Neurol. 14:266, 1976.
25. WEICKER, B. - Einheimische abakterielle entzündliche Erkrankungen des Nervensystems mit herbstlichen Endemien. Dtsch. Arch. klin. Med. 198:440, 1951.

Datas de Publicação

Publicação nesta coleção
29 Jun 2011
Data do Fascículo
Set 1986

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

[1] 1. ALBRECHTSEN, R. - The incidence of the so-called acute selective necrosis of granular layer of cerebellum in 1000 autopsied patients. Acta pathol. microbiol scand. Sect. A 85:193, 1977.

[2] 2. ALLEN, I.V. - Demyelinating diseases. In: J. Hume Adams, J.A.N. Corsellis & Li.W. Duchen (eds.): Greenfield's Neuropathology. Ed. 4. Edward Arnold Ltd., London, 1984, pg. 341.

[3] 3. van BOGAERT, L. - Post-infectious encephalomyelitis and multiple sclerosis: the significance of perivenous encephalomyelitis. J. Neuropathol. exp. Neurol. 9:219, 1950.

[4] 4. van BOGAERT, L. - Klinik der Meningoencephalitiden unbekannter Ursache (sog. Virus-Meningoencephalitiden) in Westeuropa. Nervenarzt 27:204, 1956.

[5] 5. van BOGAERT, L. - Some observations and reservations on the clinico-anatomical classification of the known encephalitides. In: L. van Bogaert, J. Radermecker, J. Hozay & A. Lowenthal (eds.): Encephalitides. Elsevier, Amsterdam, 1961, pg. 693.

[6] 6. van BOGAERT, L. - Leucoencephalitides and panencephalitides: closing remarks. In: L. van Bogaert, J. Radermecker, J. Hozay & A. Lowenthal (eds.): Encephalitides. Elsevier, Amsterdam, 1961, pg. 706.

[7] 7. BROWNELL. B. & TOMLINSON, A.H. - Virus disease of the central nervous system. In: J. Hume Adams, J.A.N. Corsellis & L.W. Duchen (eds.): Greenfield's Neuropathology. Ed. 4. Edward Arnold Ltd., London, 1984, pg. 272.

[8] 8. DONAT, J.F.; RHODES, K.H.; GROOVER., R.V. & SMITH, T.F. - Etiology and outcome in 42 children with acute nonbacterial meningoencephalitis. Mayo Clin. Proc. 55:156, 1980.

[9] 9. von ECÓNOMO, C. - Grippe-Enzephalitis und Encephalitis lethargica. Wien, klin. Wochenschr. 32:393, 1919.

[10] 10. GREENFIELD, J.G. - Encephalitis and encephalomyelitis in England and Wales during the last decade. Brain 73:141, 1950.

[11] 11. HART, M.N. & EARLE, K.M. - Hemorrhagic and perivenous encephalitis: a clinical-pathological review of 38 cases. J. Neurol. Neurosurs. Psychiat. 38:585, 1975.

[12] 12. IIZUKA, R. - Beitrag zur akuten diffusen lymphocytären Meningoencephalitis und Encephalopathie: Klinik und Neuropathologie einer nicht spezifischen Reaktionsform des zentralen Nervensystems. Arch. Psychiatr. Z. ges. Neurol. 206:705, 1965.

[13] 13. JACOB, H. - Zur klinisch-neuropathologischen Differentialdiagnose zwischen parainfektiösen (und postvaccinalen) Encephalitiden und akuten sporadischen Panleukoencephalitiden. Arch. Psychiatr. Z. ges. Neurol 197:507, 1958.

[14] 14. JACOB H. - Neuropathologie der Viruserkrankungen des Zentralnervensystems Dtsch. Z. Nervenheilkd. 182:472, 1961.

[15] 15. JELLINGER, K. & SEITELBERGER, F. - «Enzephalitis» bei Grippe. Wien, med Wochenschr. 109:201, 1959.

[16] 16. KOSKINIEMI, M.; MANNINEN, V.; VAHERI, A.; SAINIO, K.; EISTOLA, P. & KARLI, P. - Acute encephalitis: a survey of epidemiological, clinical and microbiological features covering a twelve-year period. Acta. med. scand. 209:115, 1981.

[17] 17. MANZ, H.J. - Pathology and pathogenesis of viral infections of the central nervous system. Hum. Pathol. 8:3, 1977.

[18] 18. MINAUF, M. & TATEISHI, J. - Beitrag zur «lymphocytären Encephalomeningitis». Arch. Psychiatr. Z. ges. Neurol. 209:307, 1967.

[19] 19. NATHANSON, N. & COLE, G.A. - Immunosuppression and experimental virus infection of the nervous system. Adv. Virus Res. 16:397, 1970.

[20] 20. PETERS, G. - Klinische Neuropathologie. Spezielle Pathologie der Krankheiten des zentralen und peripheren Nervensystems. Ed. 2. Georg Thieme Verlag, Stuttgart, 1970, S. 57.

[21] 21. RADERMECKER, J.; GUAZZI, G.C. & HOZAY, J. - A case of diffuse meningoencephalitis of the lymphocytic type affecting mainly the gray matter. In: L. van Bogaert, J. Radermecker, J. Hozay & A. Lowenthal (eds.): Encephalitides. Elsevier, Amsterdam, 1961, pg. 610.

[22] 22. SEITELBERGER, F. & ZISCHINSKY, H. - Rubeolen-Enzepahlitis. MMW 36:1681, 1962.

[23] 23. SRIVASTAVA, J.R. & BRIJENDRA, K.G. - Encephalitis in children: a clinical study of 409 cases. Indian J. Pediatr. 36:156, 1969.

[24] 24. WEBER, W. & ULRICH, J. - Multiple sclerosis, diffuse lymphoplasmocytic encephalitis and Alzheimer's disease in a patient with progressive dementia. Eur. Neurol. 14:266, 1976.

[25] 25. WEICKER, B. - Einheimische abakterielle entzündliche Erkrankungen des Nervensystems mit herbstlichen Endemien. Dtsch. Arch. klin. Med. 198:440, 1951.