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Neuropatia pela amiodarona: estudo clínico-patológico de dois casos

Amiodarone neuropathy clinico-pathological study of two cases

Resumos

Dois pacientes, uma mulher de 40 anos e um homem de 75 anos, apresentavam polineurite sensítivo-motora, cujo único antecedente era o uso de amiodarona há 4 e 6 anos respectivamente. O ENMG revelou quadro neuropático tipo axonal. A biópsia do nervo sural mostrou rarefação axonal, mielínica e amielínica, bem como inclusões lamelares osmiofílicas nas células de Schwann e no endotélio venular. Com a retirada da amiodarona houve regressão da polineurite. À semelhança do que foi descrito na neuropatia pelo maleato de perhexiline e pela cloroquina, a amiodarona constitui importante fator de indução de neuro-lipidose medicamentosa.


Two patients, a 40-year-old woman and a 75-year-old man, were investigated due to a chronic polyneuritis. Amiodarone was used by them to treat refractory cardiac arrythmia since 4 and 6 years before, respectively. The EMG study showed an axonal neuropathy. The light and electronmicroscopical study of sural nerve displayed a losse of large myelinated fibers and a marked reduction of unmyelinated axons, associated with osmiophilic lamellated inclusions in Schwann cells and endothelial venulae. The interruption of amiodarone therapy improved neuropathy. Considered together with similar reports in perhexiline neuropathy and with chloroquine induced neuropathy this would stress the importance of these new drug-induced neurolipidosis.


Neuropatia pela amiodarona: estudo clínico-patológico de dois casos

Amiodarone neuropathy clinico-pathological study of two cases

J. A. Maciel Jr.I; L. QueirozII

IFaculdade de Ciências Médicas da UNICAMP: Professor Assistente Doutor do Departamento de Neurologia

IIFaculdade de Ciências Médicas da UNICAMP: Professor Assistente Doutor do Departamento de Neurologia; Professor Assistente Doutor do Departamento de Anatomia Patológica

RESUMO

Dois pacientes, uma mulher de 40 anos e um homem de 75 anos, apresentavam polineurite sensítivo-motora, cujo único antecedente era o uso de amiodarona há 4 e 6 anos respectivamente. O ENMG revelou quadro neuropático tipo axonal. A biópsia do nervo sural mostrou rarefação axonal, mielínica e amielínica, bem como inclusões lamelares osmiofílicas nas células de Schwann e no endotélio venular. Com a retirada da amiodarona houve regressão da polineurite. À semelhança do que foi descrito na neuropatia pelo maleato de perhexiline e pela cloroquina, a amiodarona constitui importante fator de indução de neuro-lipidose medicamentosa.

SUMMARY

Two patients, a 40-year-old woman and a 75-year-old man, were investigated due to a chronic polyneuritis. Amiodarone was used by them to treat refractory cardiac arrythmia since 4 and 6 years before, respectively. The EMG study showed an axonal neuropathy. The light and electronmicroscopical study of sural nerve displayed a losse of large myelinated fibers and a marked reduction of unmyelinated axons, associated with osmiophilic lamellated inclusions in Schwann cells and endothelial venulae. The interruption of amiodarone therapy improved neuropathy. Considered together with similar reports in perhexiline neuropathy and with chloroquine induced neuropathy this would stress the importance of these new drug-induced neurolipidosis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Agradecimento - A Dra. A. Nucci, pela avaliação ENMG.

Departamento de Neurologia Faculdade de Ciências Médicas, UNICAMP - Caixa Postal 6111 - 13083 Campinas SP - Brasil.

  • 1. Bady B, Bourrat Ch, Trillet M, Girard PF, Carrier H - Manifestations neurologiques toxiques au cours des traitements antiangoureux. Int J Neurol 13: 371, 1978.
  • 2. Charness M, Morady F, Scheinmann M - Frequent neurologie toxicity associated with amiodarone therapy. Neurology 34: 669, 1984.
  • 3. Costa-Jussà FR, Jacobs JM - The pathology of amiodarone toxicity: I. Experimental studies with reference to changes in other tissues. Brain 108: 735, 1985.
  • 4. Costa-Jussà FR, Jacobs JM - The pathology of amiodarone toxicity: II. Peripheral neuropathy in man. Brain 108:753, 1985.
  • 5. Dudognon P, Hauw JJ - Neuropathie à l'amiodarone: lipidose médicamenteuse. Nouv Presse Méd 8: 1766, 1979.
  • 6. Dudognon P, Hauw JJ, Baecque C, Derrida JP, Escourolle R, Nick J - Neuropathie au chlorydrate d'amiodarone. Rev Neurol (Paris) 135: 527, 1979.
  • 7. Feiner LA, Younge BR, Kazmier FJ, Stricker BH, Fraunfelder FT - Optic neuropathy and amiodarone therapy. Mayo Clin Proc 62: 702, 1987.
  • 8. Fischer C, Bady B, Trillet M, Schott B - Deux cas de neuropathie à l'amiodarone. Nouv Presse Méd 6: 3643, 1977.
  • 9. Fraser AG, McQueen I, Watt AH, Stephens MR - Peripheral neuropathy during long-term high-dose amiodarone therapy. J Neurol Neurosurg Psychiat 48: 576, 1985.
  • 10. Fogoros R, Anderson K, Winkle R - Amiodarone: clinical efficacy and toxicity in 96 patients with recurrent drug-refractory arrhythmias. Circulation 68: 88, 1983.
  • 11. Greene HL, Graham EL, Werner JA - Toxic and therapeutic effects of amiodarone in the treatment of cardiac arrhythmias. J Am Coll Cardiol 2: 1114, 1983.
  • 12. Grogan WA, Narkun DM - Pseudotumor cerebri with amiodarone. J Neurol Neurosurg Psychiat 50: 651, 1987.
  • 13. Kaser HE - Amiodaron-neuropathie. Schweiz Med Wochenschr 104: 606, 1974.
  • 14. Kaser HE, Ulrich J, Wuthrich R - Amiodaron-neuropathie. Schweiz Rundsch Med (Praxis) 65: 1121, 1976.
  • 15. Lemaire JF, Autret A, Biziere K, Romet-Lemone JL, Gray F - Amiodaron neuropathy: further arguments for human drug-induced neurolipidosis. Eur Neurol 21: 65, 1982.
  • 16. Lhuillier M, Gouin B - Amiodarone et tremblement. Nouv Press Méd 1: 1844, 1972.
  • 17. Lustmann F, Monjeu G - Amiodaron and neurological side effects. Lancet 1: 568, 1974.
  • 18. Martinez-Arizala A, Sobol S, McCarthy G, Buddy RN, Rakita L - Amiodarone neuropathy. Neurology 33: 643, 1983.
  • 19. Meier C, Kauer B, Müüller V, Ludin HP - Neuromyopathy during chronic amiodarone treatment: a case repport. J Neurol 220: 231, 1979.
  • 20. Mizon JP, Rosa A, Betermiez P, Sevestre H - Neuropathie et syndrome cérébelleux à l'amiodarone. Rev Neurol (Paris) 141: 146, 1985.
  • 21. Palakurthy PR, Vasudeva I, Meckler RJ - Unusual neurotoxicity associated with amiodarone therapy. Arch Intern Med 147: 881, 1987.
  • 22. Pelissier JF, Pouget J, Cros D, De Victor B, Serratrice G, Toga M - Peripheral neuropathy induced by amiodarone chlorydrate: a clinico-pathological study. J Neurol Sci 63: 251, 1984.
  • 23. Trohman RG, Castellanos D, Castellanos A, Kessler KM - Amiodarone-induced delirium. Ann Intern Med 108: 68, 1988.
  • 24. Van Zandijcke M, Dewachter A - Pseudotumor cerebri with amiodarone. J Neurol Neurosurg Psychiat 49: 1463, 1986.

Datas de Publicação

  • Publicação nesta coleção
    01 Jun 2011
  • Data do Fascículo
    Dez 1989
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