Formas encefalopaticas de enfermedad de Chagas cronica observadas en Argentina

Abstract

Se describen las características clínicas y las manifestaciones dominantes en 22 enfermos observados entre 1963 y 1978 sobre un total de 420 con neuropatías diversas examinados en el area central Norte de la Argentina; afectados por una encefalopatía crónica, que, por hallazgos de laboratorio (demostración del parasito en sangre o en su defecto confirmacion por mas de una prueba serológica positiva) y por las correlaciones anatomoclínicas, puede ser imputada a la infección por el Trypanosoma cruzi. En la mitad o mas de los enfermos, son salientes las siguientes manifestaciones: disprosexia y confusión en 81,8%; cefalea y confusión en 72,7%; debilitamiento de reflejos músculo-tendinosos y trastornos del lenguaje en 63,6%; dispraxias en 59%; trastornos de la marcha y crisis mioclónicas en 54,5%; bradicinesias en 50%. En menor escala se encontraron: parestesias, ideas delirantes, perturbaciones cerebelares, crisis de vertigo, diplopia, lipotimias,humor fluctuante. Las menos frecuentes: disautonomia y excitacion. En 8 se hallaron evidencias semiologicas de cardiopatias y en 2 de compromiso digestivo grosero. Se analiza el alcance de esta casuistica en relación a los hallazgos anatomopatológicos en casos mortales y con referencia a lo ya conocido sobre la forma neuropatologica de la enfermedad de Chagas cronica.

Involvement of the central nervous system in the chronic form of Chagas' disease

“…The neurological findings of chronic CD (CCD), resulting from affected central nervous system (CNS) were first reported by Chagas [5], and they included the severe impairment of the motor and intellectual performances. Similar findings, including convulsive seizures presented in purely descriptive terms without a matched control group, have been described [6]. A large spectrum cognitive disorder has been observed [7], suggesting that the white matter is affected.…”

“…Some data were obtained in rural field were the conditions for an adequate differential diagnosis were limited [5,6]. We did not find major neurological deficits or dysfunctions in our CD patients as happened with others [5,6]. The clinical, EEG, and MR findings of the present series indicate limited and focal nervous system dysfunction probably associated with grey matter focal lesions and possibly white matter damage, insufficient to interfere with the CD chronic patients' daily activities.…”

“…All those series have been published in purely descriptive terms, without a matched control group or without a clinical-pathological demonstration of their relation with CD lesions. Some data were obtained in rural field were the conditions for an adequate differential diagnosis were limited [5,6]. We did not find major neurological deficits or dysfunctions in our CD patients as happened with others [5,6].…”

“…"Dysautonomia with dizziness crisis" was encountered in 7 of the 22 cases of CCD [6]. For a better understanding of the association between dizziness and CD, a specific otoneurological evaluation is recommended to establish the topography of the disorder, such evaluation being a preliminary step in investigating eventual structural lesions.…”

“…A case report has registered hemiplegic-spasmodic encephalopathy with hemiatetosis and oligofrenia [44]. Other findings like intellectual, affective, language and gait disorders, dystonia, dispraxia, myoclonic seizures, and bradycinesia have been described [6]. All those series have been published in purely descriptive terms, without a matched control group or without a clinical-pathological demonstration of their relation with CD lesions.…”