Alterações cerebrais reversíveis na síndrome hemolítico-urêmica

Santos, Antonio Carlos; Siqueira Neto, José Ibiapina; Fabio, Soraia Ramos Cabete

doi:10.1590/S0004-282X1995000200019

Resumos

A síndrome hemolítico-urêmica é patologia caracterizada pela tríade insuficiência renal aguda, anemia hemolítica microangiopática e trombocitopenia, apresentando complicações no sistema nervoso central em número considerável de casos. As alterações observadas na tomografia computadorizada são, geralmente, infartos. Os autores apresentam dois casos nos quais, além dos infartos, é vista hipodensidade difusa na substância branca, reversível com a resolução da fase aguda da doença, à semelhança de alterações descritas em casos de encefalopatia urêmica e de encefalopatia hipertensiva de outras etiologias.

síndrome hemolítico-urêmica; tomografia computadorizada; sistema nervoso central

The hemolytic-uremic syndrome is a pathology characterized by a triad consisting of acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia, with complications of the central nervous system arising in a considerable number of cases. Altered cranial computerized tomography examinations usually reveal cerebral infarctions. We present here two cases in which diffuse hypodensity was observed in the white matter in addition to the infarcts. This hypodensity was reversible after resolution of the acute phase of the disease, as is also the case for the alterations described in uremic encephalopathy and in hypertensive encephalopathy of other etiologies.

hemolytic-uremic syndrome; computed tomography; central nervous system

Alterações cerebrais reversíveis na síndrome hemolítico-urêmica

Reversible brain alterations in the hemolytic-uremic syndrome

Antonio Carlos Santos^I; José Ibiapina Siqueira Neto^II; Soraia Ramos Cabete Fabio^II

^IProfessor Assistente de Neurorradiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP)

^IIMédico Assistente, Departamento de Neuropsiquiatria e Psicologia Médica, FMRP/USP

RESUMO

A síndrome hemolítico-urêmica é patologia caracterizada pela tríade insuficiência renal aguda, anemia hemolítica microangiopática e trombocitopenia, apresentando complicações no sistema nervoso central em número considerável de casos. As alterações observadas na tomografia computadorizada são, geralmente, infartos. Os autores apresentam dois casos nos quais, além dos infartos, é vista hipodensidade difusa na substância branca, reversível com a resolução da fase aguda da doença, à semelhança de alterações descritas em casos de encefalopatia urêmica e de encefalopatia hipertensiva de outras etiologias.

Palavras-chave: síndrome hemolítico-urêmica, tomografia computadorizada, sistema nervoso central.

SUMMARY

The hemolytic-uremic syndrome is a pathology characterized by a triad consisting of acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia, with complications of the central nervous system arising in a considerable number of cases. Altered cranial computerized tomography examinations usually reveal cerebral infarctions. We present here two cases in which diffuse hypodensity was observed in the white matter in addition to the infarcts. This hypodensity was reversible after resolution of the acute phase of the disease, as is also the case for the alterations described in uremic encephalopathy and in hypertensive encephalopathy of other etiologies.

Key words:hemolytic-uremic syndrome, computed tomography, central nervous system.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 4-dezembro-1994.

Dr. Antonio Carlos Santos - Departamento de Clínica Médica - Faculdade de Medicina de Ribeirão Preto, USP - 14048-900 Ribeirão Preto SP - Brasil.

1. Bale JF, Brasher C, Sigler RL. CNS manifestations of the hemolytic-uremic syndrome. Am J Dis Child 1980,134:869-872.
2. Gaitz JP, Bamford CR. Unusual computed tomographic scan in eclampsia. Arch Neurol 1992,39:66.
3. Kaplan BS, Thomson PD, Chadarevian JP. The hemolytic-uremic syndrome. Pediatr Clin North Am 1976,23:761-777.
4. Komatsu Y, Shinohara A, Kukita C, Nose T, Maki Y. Reversible CT changes in uremic encephalopathy. AJNR 1988,9:215-216.
5. Mendelsohn DB, Hertzanu Y, Chaitowitz B, Cartwright JD. Cranial CT in the haemolytic uraemic syndrome. J Neurol Neurosurg Psychiatry 1984,47:876-878.
6. Moake JL. Haemolytic-uraemic syndrome: basic science. Lancet 1994,343:393-397.
7. Okada J, Yoshikawa K, Matsuo H, Kanno K, Oouchi M. Reversible MRI and CT findings in uremic encephalopathy. Neuroradiology 1991,33:524-526.
8. Sheth KS, Swick HM, Haworth N. Neurological involvement in hemolytic-uremic syndrome. Ann Neurol 1986,19:90-93.
9. Steele BT, Murphy N, Chuang SH, McGreal D, Arbus GS. Recovery from prolonged coma in hemolytic uremic syndrome. J Pediatr 1983, 102:402-404.
10. Steinberg A, Ish-Horowitcz M, El-Peleg O, Mor J, Branski D. Stroke in a patient with hemolytic-uremic syndrome with good outcome. Brain Dev 1986,8:70-72.
11. Tardy B, Page Y, Convers P, Mismetti P, Barrai F, Bertrand JC. Thrombotic thrombocytopenic purpura: MR findings. AJNR 1993, 14:489-490.
12. Trevathan E, Dooling EC. Large thrombotic strokes in hemolytic-uremic syndrome. J Pediatr 1987,111:863-867.
13. Upadhyaya K, Barwick K, Fishaut M, Kashgarian M, Siegel NJ. The importance on nonrenal involvement in hemolytic-uremic syndrome. Pediatrics 1980,65:115-120.

Datas de Publicação

Publicação nesta coleção
20 Jan 2011
Data do Fascículo
Jun 1995

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

[1] 1. Bale JF, Brasher C, Sigler RL. CNS manifestations of the hemolytic-uremic syndrome. Am J Dis Child 1980,134:869-872.

[2] 2. Gaitz JP, Bamford CR. Unusual computed tomographic scan in eclampsia. Arch Neurol 1992,39:66.

[3] 3. Kaplan BS, Thomson PD, Chadarevian JP. The hemolytic-uremic syndrome. Pediatr Clin North Am 1976,23:761-777.

[4] 4. Komatsu Y, Shinohara A, Kukita C, Nose T, Maki Y. Reversible CT changes in uremic encephalopathy. AJNR 1988,9:215-216.

[5] 5. Mendelsohn DB, Hertzanu Y, Chaitowitz B, Cartwright JD. Cranial CT in the haemolytic uraemic syndrome. J Neurol Neurosurg Psychiatry 1984,47:876-878.

[6] 6. Moake JL. Haemolytic-uraemic syndrome: basic science. Lancet 1994,343:393-397.

[7] 7. Okada J, Yoshikawa K, Matsuo H, Kanno K, Oouchi M. Reversible MRI and CT findings in uremic encephalopathy. Neuroradiology 1991,33:524-526.

[8] 8. Sheth KS, Swick HM, Haworth N. Neurological involvement in hemolytic-uremic syndrome. Ann Neurol 1986,19:90-93.

[9] 9. Steele BT, Murphy N, Chuang SH, McGreal D, Arbus GS. Recovery from prolonged coma in hemolytic uremic syndrome. J Pediatr 1983, 102:402-404.

[10] 10. Steinberg A, Ish-Horowitcz M, El-Peleg O, Mor J, Branski D. Stroke in a patient with hemolytic-uremic syndrome with good outcome. Brain Dev 1986,8:70-72.

[11] 11. Tardy B, Page Y, Convers P, Mismetti P, Barrai F, Bertrand JC. Thrombotic thrombocytopenic purpura: MR findings. AJNR 1993, 14:489-490.

[12] 12. Trevathan E, Dooling EC. Large thrombotic strokes in hemolytic-uremic syndrome. J Pediatr 1987,111:863-867.

[13] 13. Upadhyaya K, Barwick K, Fishaut M, Kashgarian M, Siegel NJ. The importance on nonrenal involvement in hemolytic-uremic syndrome. Pediatrics 1980,65:115-120.