Hepatitis C virus (HCV) affects 170 million people all over the world. In Brazil, the incidence of HCV-infected individuals is 5.1/100,000 habitants. The highest prevalence is seen in Acre State, in the Brazilian Amazon (22.7/100,000 habitants) 1 . HCVinfection has been associated with neurological manifestations, including peripheral neuropathy. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and distal sensory polyneuropathy have been reported. HCV-infection associated with central nervous system vasculitis was also referred. About 65% of infected patients are around 30 to 49 years old of age, and 30% will develop hepatocellular carcinoma. The physiopathology basis is still unknown 2 . It seems that there is no direct tissues lesion by the virus, but probably an immune response against the virus could develop the disease. There are few reports focusing the relation between the HCV and dysautonomia [3][4][5][6][7] . Our objective was to report the autonomic cardiovascular function in HCVinfected Brazilian patients with sensory small-fiber neuropathy. METHODSWe have included 12 consecutive HCV-infected patients with sensory small-fiber polyneuropathy. Patients were randomly selected from a cohort of more than 60 HCV patients followed in the Hepatitis Reference Center (Dr. Bordalo) of Hospital Universitário Antônio Pedro, Niterói, Rio de Janeiro, Brazil. Patients with diabetes, arterial hypertension, severe liver dysfunction, other infections, including HIV and HTLV, use of ABSTRACTThere are few studies reporting the association between hepatitis C virus (HCV) infection and disautonomia. We have evaluated the autonomic cardiovascular function in 12 patients with sensory small-fiber polyneuropathy infected by HCV. The mean age was 49±13 years old. The mean infection time was 9.6 years in six (50%) patients. Thermal and pinprick hypoesthesia was observed in distal legs in all patients. Autonomic symptoms were referred by eight (66.7%) patients. Among patients with abnormal autonomic cardiovascular test, five (41.7%) showed abnormal results in two or more tests. Valsalva maneuver was abnormal in seven (58.3%) patients. We can consider that there is an association of both parasympathetic and sympathetic efferent cardiovascular dysfunction in this group of patients.Key words: hepatitis C, dysautonomia, small-fiber polyneuropathy. RESUMOExistem poucos estudos que relatam a associação entre infecção pelo vírus da hepatite C (HCV) e disautonomia. Avaliamos a função autonômica cardiovascular em 12 pacientes com polineuropatia de fibras finas e infectados pelo HCV. A idade média foi de 49±13 anos. O tempo de infecção média foi de 9,6 anos em seis (50%) pacientes. Hipoestesia termoalgésica foi observada nos segmentos distais das pernas em todos os pacientes. Sintomas autonômicos foram relatados por oito (66,7%) pacientes. No teste autonômico cardiovascular, cinco (41,7%) apresentaram resultados anormais em dois ou mais testes. Manobra de Valsalva foi anormal em sete (58,3%) pacientes. Podemos considerar qu...
Several rare cases of polyneuropathy have been described recently. There is a very large and differential diagnosis for polyneuropathy. Epidemiology of this condition is still not exact 1 . We herein report two cases of a 67-year-old man and a 42-year-old woman with subacute progressive clinical picture of polyneuropathy and hyperIgEaemia. Those patients presented with similar symptoms, such as distal tetraparesis grade 4, generalized hyporeflexia, poor imbalance, decreased sensation of pain and temperature in the extremities, fine distal tremor and intense pain of the fingers of both hands and feet. Both showed more than 1000 ku/L of IgE in serum exams and have asthma. No other monoclonal gammopathy were found. The more common causes of polyneuropathy, like diabetes, hypothyroidism, B12 hypovitaminosis, infections like human T lymphotropic virus (HTLV 1 and 2), hepatitis C virus (HCV) and human immunodeficiency virus (HIV 1 and 2), were excluded, and there was no nerves enlargement in their physical exam. Nerve conduction studies revealed a conduction block amplitudes in motor (CMAP), lower terminal latency index (TLI) and alterations in sensory (SNAP) responses. In the first exam, we don't found SNAP responses, and the other electroneuromyography done showed small amplitude SNAP responses; prolongaded latency in nerves of upper limbs and both sural nerves were abolished (Table). Bilateral fibrillations or positives sharp waves were found in tibial anterior, gastronomies, paravertebral lumbar and cervical, gluteus medium, biceps and triceps. In both patients, the histologic features on sural nerve biopsy described no evidence of subperineurial or endoneurial edema or mononuclear inflammatory cell infiltrate in the epineurium or endoneurium. Those nerve biopsy describes mild loss of myelinated fibers and minimal axonal degeneration, and showed a slightly decrease number of thinly myelinated large caliber axons, with small onion bulb formations.We suggest that IgE-mediated allergy may be one potential cause of distal acquired demylinating symmetric neuropathy (DADS) ) weekly in the first month and a single dose by month control power and pain of male patient. Only one cycle of intravenous immunoglobulin (0.5 mg/kg/day) for five days do not demonstrated to be effective for female. The best pain treatment for female patient is using 60 mg of oxycodon four times a day. Dysimmune neuropathy is an etiologically heterogeneous entity with diverse clinical presentations. Conventional treatment options, including corticosteroids, intravenous immunoglobulin, or plasma exchange, often fail to treat dysimmune neuropathies, such as chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and monoclonal gammopathy with its subtypes. Therefore, a significant percentage of patients require adjunctive immunosuppressive therapies. Currently, several monoclonal antibodies have been tested in open-label small-sized studies or even in single cases so as to establish future directions in the therapy of diseases o...
central apneas and 2/18 a mixed pattern. Of the 9 patients in wheelchair, 3 had an increased RDI. 2/29 with PCO2N53 at the time of the exam. Snoring was present in 7/29(24%), of which two were associated with obstructive events. Mean baseline oxygen saturation was 97% and desaturation b90% present in 13/29(45%) patients. Conclusions:The prevalence of sleep-disordered breathing in children with DMD is relevant. In this study the wheelchair-bound patients didn't experience more respiratory events than patients who maintained ambulation. The number of patients receiving NIV was low.
Ulnar neuropathy at the wrist (UNW) is rare, and always challenging to localize. To increase the sensitivity and specificity of the diagnosis of UNW many authors advocate the stimulation of the ulnar nerve (UN) in the segment of the wrist and palm. The focus of this paper is to present a modified and simplified technique of sensory nerve conduction (SNC) of the UN in the wrist and palm segments and demonstrate the validity of this technique in the study of five cases of type III UNW. The SNC of UN was performed antidromically with fifth finger ring recording electrodes. The UN was stimulated 14 cm proximal to the active electrode (the standard way) and 7 cm proximal to the active electrode. The normal data from amplitude and conduction velocity (CV) ratios between the palm to finger and wrist to finger segments were obtained. Normal amplitude ratio was 1.4 to 0.76. Normal CV ratio was 0.8 to 1.23.We found evidences of abnormal SNAP amplitude ratio or substantial slowing of UN sensory fibers across the wrist in 5 of the 5 patients with electrophysiological-definite type III UNW.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.