Epilepsia e síndrome de turner apresentação de um caso e revisão da literatura

Trevisol-Bittencourt, P. C.; Sander, J. W. A. S.

doi:10.1590/S0004-282X1990000300016

Resumos

Henry Turner descreveu, em 1938, síndrome caracterizada por infantilismo sexual, pescoço alado e cubitus valgus. Disgenesia gonadal foi acrescentada à síndrome nos anos subsequentes e o critério exigido para sua confirmação diagnostica é a demonstração de cariótipo anormal, no qual é inexistente uma porção ou todos os de um cromossoma X. Ainda que nos dias atuais haja muita informação geral disponível sobre a síndrome de Turner, em relação a suas possíveis complicações neurológicas há inexplicável negligência. Nesta comunicação revemos o caso de uma paciente com esta síndrome, que desenvolveu epilepsia severa a partir dos 16 anos de idade. Em complementação, revisão das publicações sobre o assunto nos últimos 20 anos, com ênfase às alterações neurológicas associadas à condição, é apresentada. O constante aparecimento de malformações extracranianas, muitas das quais estando empírica e freqüentemente combinadas a anomalias no SNC, bem como a incidência relativamente alta de deficits nestas pacientes, parecem justificar a hipótese de que em certa porcentagem de casos, uma malformação do SNC, não necessariamente de tipo vascular, poderá ser parte ainda não descrita da síndrome.

Fifty years ago Henry Turner identified the association of sexual infantilism, webbed neck and cubitus valgus to be a separate entity and subsequently gonadal dysgenesis was appended to the definition. Twenty years after the original report it was demonstrated that in typical patients with Turner's syndrome the chromosomal composition was 45,X0 and in addition cases of mosaicism were described. Although much general information is now available about Turner's syndrome the neurological complications are largely neglected. In this paper we review the case of a patient with Turner's syndrome who at age of 16 years developed severe epilepsy. In addition, a survey of the literature concerning neurological abnormalities associated with this syndrome is presented. It seems clear that neurological symptoms in patients with Turner's syndrome deserves consideration for many reasons; may be the most significant is the evidence that patients with this syndrome have a high incidence of vascular abnormalities, which may also affect the CNS. Empirically patients with Turner's syndrome are at risk of developing cerebral vascular diseases. Also the relatively high frequency of cognitive abnormalities in these patients seems to justify the hypothesis that in a certain percentage of cases a CNS dysfunction or malformation, not necessarily of a vascular nature, may be a component of the syndrome still nor described.

P. C. Trevisol-Bittencourt^I; J. W. A. S. Sander^II

^IDepartamento de Neurologia, Hospital Universitário, Universidade Federal de Santa Catarina; National Hospital - Chalfont Center for Epilepsy

^IIINSEG/Epilepsy Research Group, Institute of Neurology, London UK

RESUMO

Henry Turner descreveu, em 1938, síndrome caracterizada por infantilismo sexual, pescoço alado e cubitus valgus. Disgenesia gonadal foi acrescentada à síndrome nos anos subsequentes e o critério exigido para sua confirmação diagnostica é a demonstração de cariótipo anormal, no qual é inexistente uma porção ou todos os de um cromossoma X. Ainda que nos dias atuais haja muita informação geral disponível sobre a síndrome de Turner, em relação a suas possíveis complicações neurológicas há inexplicável negligência. Nesta comunicação revemos o caso de uma paciente com esta síndrome, que desenvolveu epilepsia severa a partir dos 16 anos de idade. Em complementação, revisão das publicações sobre o assunto nos últimos 20 anos, com ênfase às alterações neurológicas associadas à condição, é apresentada. O constante aparecimento de malformações extracranianas, muitas das quais estando empírica e freqüentemente combinadas a anomalias no SNC, bem como a incidência relativamente alta de deficits nestas pacientes, parecem justificar a hipótese de que em certa porcentagem de casos, uma malformação do SNC, não necessariamente de tipo vascular, poderá ser parte ainda não descrita da síndrome.

SUMMARY

Fifty years ago Henry Turner identified the association of sexual infantilism, webbed neck and cubitus valgus to be a separate entity and subsequently gonadal dysgenesis was appended to the definition. Twenty years after the original report it was demonstrated that in typical patients with Turner's syndrome the chromosomal composition was 45,X0 and in addition cases of mosaicism were described. Although much general information is now available about Turner's syndrome the neurological complications are largely neglected. In this paper we review the case of a patient with Turner's syndrome who at age of 16 years developed severe epilepsy. In addition, a survey of the literature concerning neurological abnormalities associated with this syndrome is presented. It seems clear that neurological symptoms in patients with Turner's syndrome deserves consideration for many reasons; may be the most significant is the evidence that patients with this syndrome have a high incidence of vascular abnormalities, which may also affect the CNS. Empirically patients with Turner's syndrome are at risk of developing cerebral vascular diseases. Also the relatively high frequency of cognitive abnormalities in these patients seems to justify the hypothesis that in a certain percentage of cases a CNS dysfunction or malformation, not necessarily of a vascular nature, may be a component of the syndrome still nor described.

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Dr. P. C. Trevisol-Bittencourt - National Hospital-Chalfont Centre for Epilepsy - Chalfont St. Peter, Gerrards Cross. Bucks. SL9 ORJ - UK.

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