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Hemiplegia espástica pura de origem piramidal

Pure spastic hemiplegia of pyramidal origin

Resumos

Três pacientes acometidos de hemiplegia espástica pura apresentaram, à tomografia computadorizada, imagens hipodensas envolvendo regiões dos hemisférios cerebrais hoje identificadas como locais de passagem dos feixes córtico-nuclear e piramidal. Em nenhum deles se registraram alterações de forma, latência e amplitude dos potenciais evocados sômato-sensitivos. Com base nestes casos e em outros idênticos, recolhidos da literatura, reafirmamos a validade anátomo-clínica da síndrome piramidal, constituída de paresia, hiper-reflexia, espasticidade e sinal de Babinski. O reconhecimento da existência de síndromes piramidais deficitárias, levou-nos a postular a heterogeneidade anatômica e funcional do feixe piramidal, através do conceito de «controle funcional diferencial». Aparentemente, estas conclusões se aplicam integralmente apenas ao ser humano.


The relationship between the interruption of the human pyramidal tract and its attendant clinical manifestations has been a matter of concern to neurologists and neurosurgeons for over a century. We presently report three cases of unilateral pyramidal tract ischemic lesions within the cerebral hemispheres who presented with a contralateral pure spastic hemiplegia syndrome. In none could we find any disturbance in the somato-sensitive evoked potentials of the four limbs. The review of some cases on record since the time of Charcot and Erb has made it clear that the pyramidal syndrome is a valid clinical concept which should be qualified according to the particular animal species one is referring to. In man, it manifests itself by paresis, hyperactive muscular reflexes, spasticity and Babinski sign. Based on this evidence we propose the idea of a «differential control* exerted by the pyramidal tract upon the segmental neuronal pool as its key mode of normal functioning.


Ricardo de Oliveira SouzaI; Dayse L. GusmãoII; Wagner Martignoni de FigueiredoIII; Antonio C. Goulart DuarteIII

IServiço de Neurologia (Prof. Dr. Hélcio Alvarenga), Hospital Universitário Gaffrée e Guinle, UNI-RIO

IIServiço de Neurologia (Dr. Nunjo Finkel), Santa Casa de Misericórdia do Rio de Janeiro

IIIServiço de Clínica Médica III (Prof. Dr. Omar da Rosa Santos), Hospital Universitário Gaffrée e Guinle, UNI-RIO

RESUMO

Três pacientes acometidos de hemiplegia espástica pura apresentaram, à tomografia computadorizada, imagens hipodensas envolvendo regiões dos hemisférios cerebrais hoje identificadas como locais de passagem dos feixes córtico-nuclear e piramidal. Em nenhum deles se registraram alterações de forma, latência e amplitude dos potenciais evocados sômato-sensitivos. Com base nestes casos e em outros idênticos, recolhidos da literatura, reafirmamos a validade anátomo-clínica da síndrome piramidal, constituída de paresia, hiper-reflexia, espasticidade e sinal de Babinski. O reconhecimento da existência de síndromes piramidais deficitárias, levou-nos a postular a heterogeneidade anatômica e funcional do feixe piramidal, através do conceito de «controle funcional diferencial». Aparentemente, estas conclusões se aplicam integralmente apenas ao ser humano.

SUMMARY

The relationship between the interruption of the human pyramidal tract and its attendant clinical manifestations has been a matter of concern to neurologists and neurosurgeons for over a century. We presently report three cases of unilateral pyramidal tract ischemic lesions within the cerebral hemispheres who presented with a contralateral pure spastic hemiplegia syndrome. In none could we find any disturbance in the somato-sensitive evoked potentials of the four limbs. The review of some cases on record since the time of Charcot and Erb has made it clear that the pyramidal syndrome is a valid clinical concept which should be qualified according to the particular animal species one is referring to. In man, it manifests itself by paresis, hyperactive muscular reflexes, spasticity and Babinski sign. Based on this evidence we propose the idea of a «differential control* exerted by the pyramidal tract upon the segmental neuronal pool as its key mode of normal functioning.

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Agradecimentos - Desejamos expressar nosso agradecimento a prestimosa colaboração dos Drs. Rogério José dos Reis, Denise Nicaretta Hack, Levi Inimá de Miranda e Marcelo Heitor Mendes, no acompanhamento dos pacientes apresentados no presente trabalho. Estamos em débito com o Sr. José Manoel da Costa, que fez as ilustrações.

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  • Hemiplegia espástica pura de origem piramidal

    Pure spastic hemiplegia of pyramidal origin
  • Datas de Publicação

    • Publicação nesta coleção
      22 Jun 2011
    • Data do Fascículo
      Mar 1988
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