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Amaurotic family idiocy has rarely been described in Brazilian literature. The infantile form of the disease was studied and described by Juli\l=a~\o,Magalh\l=a~\es and Brandi. Marques 1 (1943) reviewed the subject and presented a case characterized by amaurosis, atrophy of the optic nerve, pigmentary retinosis, muscular hypotonia, convulsions, mental regression and the added stigma of spina bifida. The purpose of this paper is to present a case of amaurotic family idiocy in which diagnosis was possible only after careful histologic study. REPORT OF CASEThe patient was first seen in the neurologic clinic of the Getulio Vargas Hospital at the age of 17 years. After preliminary examination, he was admitted to the hospital, with well defined signs of a dystonic syndrome, characterized by slow and spasmodic twitching of the face, spasmodic twitching of the trunk and neck and slow and spasmodic hyperkinetic movements of both the upper and the lower extremities.The family history revealed that the patient's mother and father were living and well and were not blood relatives. The family antecedents were Brazilians of Portuguese extraction, not of Jewish origin. There was no history suggestive of neurologic disease in any member of the family except for 1 sibling, aged 9, who for the past two years had had neurologic signs similar to those presented by the patient.The birth of the patient had been normal, no forceps being used. The weight at birth was 7 pounds 8 ounces (3,400 Gm.). He had had no serious disease or operation. He was said to have grown and developed well up to 9 years of age. At the time of examination he was 4 feet 11 inches (149 cm.) in height and weighed 106 pounds (48.1 Kg.). There were no bodily deformities; the face presented twitchings. Examination of the heart, lungs and abdomen revealed nothing abnormal. The pulse rate was 80 and the blood pressure 110 systolic and 60 diastolic. The blood and the cerebrospinal fluid gave negative reactions for syphilis.The parents dated the onset of the illness to the age of 9 years. Prior to that time the child had been entirely normal, physically and mentally, and he was progressing well in school. At the age of 9, dysarthria and a mild intention tremor developed, and progressive mental deterioration was noted. No visual disturbances From the Neurological Clinic of the Getulio Vargas Hospital.
Amaurotic family idiocy has rarely been described in Brazilian literature. The infantile form of the disease was studied and described by Juli\l=a~\o,Magalh\l=a~\es and Brandi. Marques 1 (1943) reviewed the subject and presented a case characterized by amaurosis, atrophy of the optic nerve, pigmentary retinosis, muscular hypotonia, convulsions, mental regression and the added stigma of spina bifida. The purpose of this paper is to present a case of amaurotic family idiocy in which diagnosis was possible only after careful histologic study. REPORT OF CASEThe patient was first seen in the neurologic clinic of the Getulio Vargas Hospital at the age of 17 years. After preliminary examination, he was admitted to the hospital, with well defined signs of a dystonic syndrome, characterized by slow and spasmodic twitching of the face, spasmodic twitching of the trunk and neck and slow and spasmodic hyperkinetic movements of both the upper and the lower extremities.The family history revealed that the patient's mother and father were living and well and were not blood relatives. The family antecedents were Brazilians of Portuguese extraction, not of Jewish origin. There was no history suggestive of neurologic disease in any member of the family except for 1 sibling, aged 9, who for the past two years had had neurologic signs similar to those presented by the patient.The birth of the patient had been normal, no forceps being used. The weight at birth was 7 pounds 8 ounces (3,400 Gm.). He had had no serious disease or operation. He was said to have grown and developed well up to 9 years of age. At the time of examination he was 4 feet 11 inches (149 cm.) in height and weighed 106 pounds (48.1 Kg.). There were no bodily deformities; the face presented twitchings. Examination of the heart, lungs and abdomen revealed nothing abnormal. The pulse rate was 80 and the blood pressure 110 systolic and 60 diastolic. The blood and the cerebrospinal fluid gave negative reactions for syphilis.The parents dated the onset of the illness to the age of 9 years. Prior to that time the child had been entirely normal, physically and mentally, and he was progressing well in school. At the age of 9, dysarthria and a mild intention tremor developed, and progressive mental deterioration was noted. No visual disturbances From the Neurological Clinic of the Getulio Vargas Hospital.
* Ou ainda sindroma de Hunter-Hurler, como usaram A. Lefèvre e colaboradores, ao publicarem os únicos casos brasileiros conhecidos. Empregamos em vez de gargoilismo, um anglicismo, tradução literal de gargoylism, o têrmo português de gargulismo; gárgula, palavra portuguêsa, significa biqueira de catedral ornamentada com rostos estranhos, de órbitas afastadas.
Foram observados três irmãos portadores de idiotia amaurótica juvenil. A sintomatologia compunha-se, basicamente, de uma tríade, representada por: a - distúrbios visuais (baixa progressiva da visão, culminando, após poucos meses, em amaurose), que constituíram, nos três irmãos, a manifestação inicial da moléstia, surgindo entre os 6 e 7 anos de idade; b - desordens psíquicas significativas, apresentando-se, no caso 1, concomitantemente às desordens visuais, traduzindo-se sobretudo por intensa agitação psicomotora, que se prolongou até o período final da moléstia (a paciente faleceu aos 17 anos de idade); o rebaixamento global das funções intelectuais era também pronunciado no caso 2 e menos intenso no caso 3; c - crises convulsivas, que se estabeleceram a partir dos 11 anos de idade em todos os casos. Ao exame sômato-neurológico, apenas se destaca hiporreflexia osteotendínea generalizada (casos 1 e 2); não se evidenciaram manifestações extrapiramidais, cerebelares ou piramidais. O exame dos fundos oculares demonstrou, ao lado de atrofia das papilas, retinose pigmentar, evidente nos casos 2 e 3. São particularmente salientados os seguintes estudos levados a efeito nos casos 2 e 3: o exame dos tipos sangüíneos, que concluiu pela existência de estreita consangüinidade nos pais dos pacientes (primos-irmãos); o estudo eletrencefalográfico; a determinação eletroforética das proteínas, lipo e glicoproteínas plasmáticas, que revelou acentuadas alterações nesses três componentes; a análise eletroforética das proteínas do liqüido cefalorraqueano, que evidenciou diminuição da relação albumina/globulina, especialmente ligada a aumento da fração γ, no caso 2 (mais evoluído); no caso 3 verificou-se apenas aumento isolado da γ globulina liquórica, com queda da fração β. Finalmente, foi feito o estudo hematológico dos linfócitos vacuolizados, que ocorreram em alta proporção no sangue periférico dos casos 2 e 3 e de uma prima-irmã dos mesmos, com moléstia semelhante, mostrando-se êsse distúrbio estreitamente relacionado com a gravidade do quadro clínico.
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