Polineuropatia aguda atipica na vigencia de doença de Chagas cronica: registro de um caso

Fortes-Rêgo, J.

doi:10.1590/S0004-282X1984000100015

Resumos

O autor apresenta o caso de paciente chagásico de 47 anos, que desenvolveu de modo agudo uma polineuropatia atípica, cujo elemento mais saliente consistiu de uma ptose palpebral unilateral completa. A nomenclatura e a conceituação clínica da síndrome de Guillain-Barré-Strohl e de suas variantes são discutidas, com maior ênfase para a síndrome de Miller Fisher. É discutida também uma eventual participação da tripanosomíase no quadro neurológico.

The author reports the case of a 47-year-old man who developed an acute polyneuritis in the course of the chronic Chagas'disease. Neurological examination on admission forty-five days after onset showed total ptosis of the left eyelid without internal and external ophthalmoplegia. There was moderate diffuse weakness in the limbs. Tendon reflexes were depressed. Plantar responses were normal. The cerebrospinal fluid cell count and protein level were raised. The relationship between chronic Chagas'disease and peripheral polyneuritis is discussed.

Polineuropatia aguda atipica na vigencia de doença de Chagas cronica. Registro de um caso

Atypical acute polyneuritis and chronic Chagas'disease. Report of one case

J. Fortes-Rêgo

Professor de Neurologia. Departamento de Medicina Especializada da Faculdade de Ciências da Saúde da Universidade de Brasilia

RESUMO

O autor apresenta o caso de paciente chagásico de 47 anos, que desenvolveu de modo agudo uma polineuropatia atípica, cujo elemento mais saliente consistiu de uma ptose palpebral unilateral completa. A nomenclatura e a conceituação clínica da síndrome de Guillain-Barré-Strohl e de suas variantes são discutidas, com maior ênfase para a síndrome de Miller Fisher. É discutida também uma eventual participação da tripanosomíase no quadro neurológico.

SUMMARY

The author reports the case of a 47-year-old man who developed an acute polyneuritis in the course of the chronic Chagas'disease. Neurological examination on admission forty-five days after onset showed total ptosis of the left eyelid without internal and external ophthalmoplegia. There was moderate diffuse weakness in the limbs. Tendon reflexes were depressed. Plantar responses were normal. The cerebrospinal fluid cell count and protein level were raised. The relationship between chronic Chagas'disease and peripheral polyneuritis is discussed.

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Trabalho realizado no Departamento de Medicina Especializada da Faculdade de Ciências da Saúde da Universidade de Brasilia.

Universidade de Brasília - Departamento de Medicina Especializada - 70.910 Brasília, DF - Brasil.

1. BIGNAMI, A. & SERVI, M. - Acr-te internal and external ophthalmoplegia with muscle weakness. Lancet 1:1110, 1963.
2. BLAU, I.; CASSON, I.; LIEBERMAN, A. & WEISS, E. - The not-so-benign Miller Fisher syndrome. Arch. Neurol. (Chicago) 37:384, 1980.
3. BUGE, A.; RANCUREL, G.; BRAULT, J.L. & GUILLEMANDSCHADER, B. - Polyradiculonévrite aiguë à forme ophtalmoplégique. Récidive à 12 ans d'intervalle. Nouv. Presse Med. 11:281, 1982.
4. CORSTON, R.N.; McGALE, E.H.F.; STONIER, C; ABER, G.M. & HUTCHINSON, E.C. - Abnormalities of cerebrospinal fluid amino acids in patients with the Guillain-Barré syndrome. J. Neurol. Neurosurg. Psychiat. 44:86, 1981.
5. ELIZAN, T.S.; SPIRE, J.P.; ANDIMAN, R.M.; BAUGHMAN, F.A. & LLOYD-SMITH, D.L. - Syndrome of acute idiopathic opthalmoplegia with ataxia and arreflexia. Neurology (Minneapolis) 21:281, 1971.
6. FISHER, M. - An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). New Engl. J. med. 255:57, 1956.
7. FORTES-RÊGO, J. - Polineuropatias chagásicas. Arq. Neuro-Psiquiat. (São Paulo) 37:165, 1979.
8. FORTES-RÊGO, J. - Paralisia facial periférica isolada: uma condição controversa. Diplomata Editora. Brasilia, 1981.
9. FORTES-RÊGO, J.; MACEDO, V.O. & PRATA, A. - Alterações neurológicas periféricas na doença de Chagas crônica. Arq. Neuro-Psiquiat. (São Paulo) 38:45, 1980.
10. GIBBERD, F.B. - Ophthalmoplegia in acute polyneuritis. Arch. Neurol. (Chicago) 23:161, 1970.
11. GIBBERD, F.B. & KELLY, R.E. - Acute internal and external ophthalmoplegia with polyradic litis of probable virus aetiology. Brain 87:657, 1964.
12. GUILLAIN, G. - Radiculoneuritis with acellular hyperalbuminosis of the cerebrospinal fluid. Arch. Neurol. Psychiat. 36:975, 1936.
13. GUILLAIN, G.; BARRÉ, J.A. & STROHL, A. - Concerning a syndrome of radicular neuritis with hyperalbuminosis of the cerebrospinal fluid without cellular reaction. Notes on the clinical and graphic characteristics of the tendon reflexes. In Brody, I.A. & Wilkins, R.H.: Guillain-Barré-Strohl syndrome. Arch. Neurol. (Chicago) 18:449, 1968.
14. KEENLYSIDE, R.A.; SCHONBERGER, L.B.; BREGMAN, D.J. & BOLYAI, J.Z.S. - Fatal Guillain-Barré syndrome after the national influenza immunization program. Neurology (Minneapolis) 30:929, 1980.
15. MARSHALL, J. - The Landry-Guillain-Barré syndrome. Brain 86:55, 1963.
16. McFARLAND, H.R. & HELLER, G.L. - Guillain-Barré disease complex. Arch. Neurol. (Chicago) 14:196, 1966.
¹⁷
NATIONAL Institute of Neurological and Communicative Disorders. Committee Formulates Definition and Criterions of Guillain-Barré syndrome to Aid in Diagnosis. J. amer. Med. Assoc. 240:1709, 1978.
18. NOUAILHAT, F.; BOURDAIN, J.L.; ROCHER, P. & QUEVAUVILLERS, J. - Syndrome de M. Fisher après sérothérapie antitétanique. Nouv. Presse Méd. 8:2832, 1979.
19. OSLER, L.D. & SIDELL, A.D. - The Guillain-Barré syndrome. The need for exact diagnostic criteria. N. Engl. J. Med. 262:964, 1960.
20. QAQUNDAH, B.Y. & TAYLOR, W.F. - Miller Fisher syndrome in a 22-month-old child. J. Pediat. 77:868, 1970.
21. SWASH, M. - Clinical aspects of Guillain-Barré syndrome: a review. J. royal Soc. Med. 72:670, 1979.
22. WILLIAMS, D.; BRUST, J.C.M.; ABRAMS, G.; CHALLENOR, Y. & DEVEREAUX, M. - Landry-Guillain-Barré syndrome with abnormal pupils and normal eye movements: a case report. Neurology (Minneapolis) 29:1033, 1979.

Datas de Publicação

Publicação nesta coleção
14 Ago 2012
Data do Fascículo
Mar 1984

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

[1] 1. BIGNAMI, A. & SERVI, M. - Acr-te internal and external ophthalmoplegia with muscle weakness. Lancet 1:1110, 1963.

[2] 2. BLAU, I.; CASSON, I.; LIEBERMAN, A. & WEISS, E. - The not-so-benign Miller Fisher syndrome. Arch. Neurol. (Chicago) 37:384, 1980.

[3] 3. BUGE, A.; RANCUREL, G.; BRAULT, J.L. & GUILLEMANDSCHADER, B. - Polyradiculonévrite aiguë à forme ophtalmoplégique. Récidive à 12 ans d'intervalle. Nouv. Presse Med. 11:281, 1982.

[4] 4. CORSTON, R.N.; McGALE, E.H.F.; STONIER, C; ABER, G.M. & HUTCHINSON, E.C. - Abnormalities of cerebrospinal fluid amino acids in patients with the Guillain-Barré syndrome. J. Neurol. Neurosurg. Psychiat. 44:86, 1981.

[5] 5. ELIZAN, T.S.; SPIRE, J.P.; ANDIMAN, R.M.; BAUGHMAN, F.A. & LLOYD-SMITH, D.L. - Syndrome of acute idiopathic opthalmoplegia with ataxia and arreflexia. Neurology (Minneapolis) 21:281, 1971.

[6] 6. FISHER, M. - An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). New Engl. J. med. 255:57, 1956.

[7] 7. FORTES-RÊGO, J. - Polineuropatias chagásicas. Arq. Neuro-Psiquiat. (São Paulo) 37:165, 1979.

[8] 8. FORTES-RÊGO, J. - Paralisia facial periférica isolada: uma condição controversa. Diplomata Editora. Brasilia, 1981.

[9] 9. FORTES-RÊGO, J.; MACEDO, V.O. & PRATA, A. - Alterações neurológicas periféricas na doença de Chagas crônica. Arq. Neuro-Psiquiat. (São Paulo) 38:45, 1980.

[10] 10. GIBBERD, F.B. - Ophthalmoplegia in acute polyneuritis. Arch. Neurol. (Chicago) 23:161, 1970.

[11] 11. GIBBERD, F.B. & KELLY, R.E. - Acute internal and external ophthalmoplegia with polyradic litis of probable virus aetiology. Brain 87:657, 1964.

[12] 12. GUILLAIN, G. - Radiculoneuritis with acellular hyperalbuminosis of the cerebrospinal fluid. Arch. Neurol. Psychiat. 36:975, 1936.

[13] 13. GUILLAIN, G.; BARRÉ, J.A. & STROHL, A. - Concerning a syndrome of radicular neuritis with hyperalbuminosis of the cerebrospinal fluid without cellular reaction. Notes on the clinical and graphic characteristics of the tendon reflexes. In Brody, I.A. & Wilkins, R.H.: Guillain-Barré-Strohl syndrome. Arch. Neurol. (Chicago) 18:449, 1968.

[14] 14. KEENLYSIDE, R.A.; SCHONBERGER, L.B.; BREGMAN, D.J. & BOLYAI, J.Z.S. - Fatal Guillain-Barré syndrome after the national influenza immunization program. Neurology (Minneapolis) 30:929, 1980.

[15] 15. MARSHALL, J. - The Landry-Guillain-Barré syndrome. Brain 86:55, 1963.

[16] 16. McFARLAND, H.R. & HELLER, G.L. - Guillain-Barré disease complex. Arch. Neurol. (Chicago) 14:196, 1966.

[17] ¹⁷
NATIONAL Institute of Neurological and Communicative Disorders. Committee Formulates Definition and Criterions of Guillain-Barré syndrome to Aid in Diagnosis. J. amer. Med. Assoc. 240:1709, 1978.

[18] 18. NOUAILHAT, F.; BOURDAIN, J.L.; ROCHER, P. & QUEVAUVILLERS, J. - Syndrome de M. Fisher après sérothérapie antitétanique. Nouv. Presse Méd. 8:2832, 1979.

[19] 19. OSLER, L.D. & SIDELL, A.D. - The Guillain-Barré syndrome. The need for exact diagnostic criteria. N. Engl. J. Med. 262:964, 1960.

[20] 20. QAQUNDAH, B.Y. & TAYLOR, W.F. - Miller Fisher syndrome in a 22-month-old child. J. Pediat. 77:868, 1970.

[21] 21. SWASH, M. - Clinical aspects of Guillain-Barré syndrome: a review. J. royal Soc. Med. 72:670, 1979.

[22] 22. WILLIAMS, D.; BRUST, J.C.M.; ABRAMS, G.; CHALLENOR, Y. & DEVEREAUX, M. - Landry-Guillain-Barré syndrome with abnormal pupils and normal eye movements: a case report. Neurology (Minneapolis) 29:1033, 1979.

Brasil

Brasil

Polineuropatia aguda atipica na vigencia de doença de Chagas cronica: registro de um caso

Atypical acute polyneuritis and chronic Chagas'disease: report of one case

Resumos

Datas de Publicação