Mielopatias: considerações clínicas e aspectos etiológicos

Brito, Jussara; Nóbrega, Paulo Virgolino da

doi:10.1590/s0004-282x2003000500021

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…The exact frequency of myelopathy in these patients has never been properly studied, in part because of the wide variations in clinical expression 6 . Nowadays, neuroschistosomiasis is considered the third most common cause of myelopathy, after traumatic and tumor involvements 7,8 . The presence and clinical significance neurological lesions depend on the combination of the presence of eggs and the immune response of the host.…”

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confidence: 99%

Epidemiological aspects in neuroschistosomiasis

Vidal

Gurgel

Ferreira

et al. 2010

Arq. Neuro-Psiquiatr.

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The urbanization process of schistosomiasis has been described in the literature. The present report shows and discusses some epidemiological aspects of neuroschistosomiasis that emphasizes this trend. Method: The study was done between July, 2005 and June, 2006, and consisted of spinal cord schistosomiasis carriers at the moment of diagnosis. These patients were evaluated whatever the origin and period of the year that they developed the symptoms. Results: A total of 13 patients were evaluated. Ten cases (76.92%) came from the Metropolitan Region of Recife, while the other zones (Zona da Mata, Agreste e Sertão) contributed with just three cases (23.07%). October, November and December (post rainy period) concentrated the majority of the cases (61.54%). Conclusion: The high spatial and temporal concentration of cases in relation to a recent endemic area for Schistosomiasis suggests that the immunological status may be an important factor for installation of Sschistosomal myelitis. Key words: epidemiology, schistosomiasis mansoni, neuroschistosomiasis, myelitis. Aspectos epidemiologicos na neuroesquistossomoseReSuMo O processo de urbanização da esquistossomose vem sendo descrito na literatura. O presente estudo apresenta e discute alguns aspectos epidemiológicos na neuroesquistossomose que confirmam essa tendência. Método: O estudo foi realizado entre julho de 2005 e junho de 2006, sendo composto por portadores de mielite esquistossomótica no momento do diagnóstico. Os pacientes foram avaliados quanto à procedência e ao período do ano que desenvolveram a doença. Resultados: No total foram 13 pacientes avaliados, sendo 10 casos (76,92%) provenientes da Região Metropolitana do Recife, enquanto as demais regiões (Zona da Mata, Agreste e Sertão) contribuíram com apenas um caso cada. Os meses de outubro, novembro e dezembro concentraram a maioria dos pacientes (61,54%). Conclusão: A alta concentração espacial e temporal de casos em relação a uma área endêmica recente para esquistossomose sugere que a participação de fatores imunológicos possa ser importante para o desenvolvimento de sua forma medular. Palavras-chave: epidemiologia, esquistossomose mansoni, neuroesquistossomose, mielite.

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confidence: 99%

Epidemiological aspects in neuroschistosomiasis

Vidal

Gurgel

Ferreira

et al. 2010

Arq. Neuro-Psiquiatr.

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“…The disease is characterized by the emergence of acute or sub acute signs and symptoms of motor, neurological, and autonomic dysfunction related to the nervous tracts of the spinal cord [6]. TM often occurs due to inflammatory and infectious processes, rheumatologic, neoplastic, iatrogenic, demyelinating, compressive, actinic as well as idioapthic diseases [7,8]. TM associated to HCV infection has recently been reported, and although the causal mechanism has not been fully established yet, it is hypothesized that the virus may act directly in the development of TM, or lead to immune-mediated injury.…”

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confidence: 99%

Transverse myelitis associated to HCV infection

Carli¹,

Pannebeker²,

Pedro³

et al. 2009

Braz J Infect Dis

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Complications involving the central nervous system in patients suffering from hepatitis C virus (HCV) infection have been rare. Among them, it appears the transverse myelitis, which has already been reported in likely association with HCV. This paper presents the case study of a 65-year-old woman who developed cervical transverse myelitis linked to chronic HCV infection and anti-HCV antibodies in the spinal fluid, being excluded other etiologies for transverse myelitis. Current evidence has reinforced the likely association between chronic HCV infection and transverse myelitis, especially as recurrent manifestations of the disease. These findings reveal the need for more searching to establish the causal relationship between transverse myelitis and hepatitis C. Key-Words: Central Nervous System, HCV infection, transverse myelitis. The World Health Organization estimates that infection by the hepatitis C virus (HCV) affects around 3% of the world population [1], being one of the main causes of the chronic hepatic disease. In HCV-positive patients, extra-hepatic symptoms are reported in up to 74% of the cases, 10% to 15% of which regarding the neurological changes, mainly in the peripheral nervous system, and in this context associated to the cryoglobulinaemia. Manifestations observed in the central nervous system (CNS) include chronic forms of encephalopathy, epilepsy, normal pressure hydrocephaly, ischemic encephalovascular syndrome, Ekbom syndrome, and encephalomyelitis [2][3][4][5].Transverse myelitis (TM) is a demyelinating disease of the spinal cord. The disease is characterized by the emergence of acute or sub acute signs and symptoms of motor, neurological, and autonomic dysfunction related to the nervous tracts of the spinal cord [6]. TM often occurs due to inflammatory and infectious processes, rheumatologic, neoplastic, iatrogenic, demyelinating, compressive, actinic as well as idioapthic diseases [7,8]. TM associated to HCV infection has recently been reported, and although the causal mechanism has not been fully established yet, it is hypothesized that the virus may act directly in the development of TM, or lead to immune-mediated injury.This paper is a case study of a patient who suffered from cervico-dorsal spinal cord myelitis, In association with updated literature, this study case adds evidence about the association between HCV and TM. Case ReportThe patient was a nulliparous, non-smoker 65-year-old caucasian woman previously alcoholic but abstemious for eight years, with obesity degree 3, hypertension, diabetes mellitus type II, and with a metallic mitral valve for nine months. The patient was from the central region of the state of Rio Grande do Sul, Brazil, and had been taking warfarin, metphormin, glibenclamide, hydrochlothiazide, metoprolol, enalipril, and furosemide at the time of hospital admission.On admission, complaints reported by the patient included strong and progressive thoracolumbar pain for 30 days, which evolved with the loss of strength and sensitivity in lower limbs five days ...

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“…We excluded from the study other causes of transverse myelitis, clinically and radiologically, such as spinal cord compression, infectious myelopathy, including parasitic etiology (e.g. Schistosoma mansoni , which is endemic in northeast Brazil) [27], spinal cord ischemia or bleeding, vitamin B12 and folate deficiency, among others. We also excluded patients co-infected with hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus types 1 and 2 (HIV-1/2) and HTLV type 2 in the HTLV-1 seropositive group.…”

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confidence: 99%

Aquaporin-4 Antibodies Are Not Related to HTLV-1 Associated Myelopathy

et al. 2012

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IntroductionThe seroprevalence of human T-cell leukemia virus type 1 (HTLV-1) is very high among Brazilians (∼1∶200). HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP) is the most common neurological complication of HTLV-1 infection. HAM/TSP can present with an acute/subacute form of longitudinally extensive myelitis, which can be confused with lesions seen in aquaporin-4 antibody (AQP4-Ab) positive neuromyelitis optica spectrum disorders (NMOSD) on MRI. Moreover, clinical attacks in patients with NMOSD have been shown to be preceded by viral infections in around 30% of cases.ObjectiveTo evaluate the frequency of AQP4-Ab in patients with HAM/TSP. To evaluate the frequency of HTLV-1 infection in patients with NMOSD.Patients and Methods23 Brazilian patients with HAM/TSP, 20 asymptomatic HTLV-1+ serostatus patients, and 34 with NMOSD were tested for AQP4-Ab using a standardized recombinant cell based assay. In addition, all patients were tested for HTLV-1 by ELISA and Western blotting.Results20/34 NMOSD patients were positive for AQP4-Ab but none of the HAM/TSP patients and none of the asymptomatic HTLV-1 infected individuals. Conversely, all AQP4-Ab-positive NMOSD patients were negative for HTLV-1 antibodies. One patient with HAM/TSP developed optic neuritis in addition to subacute LETM; this patient was AQP4-Ab negative as well. Patients were found to be predominantly female and of African descent both in the NMOSD and in the HAM/TSP group; Osame scale and expanded disability status scale scores did not differ significantly between the two groups.ConclusionsOur results argue both against a role of antibodies to AQP4 in the pathogenesis of HAM/TSP and against an association between HTLV-1 infection and the development of AQP4-Ab. Moreover, the absence of HTLV-1 in all patients with NMOSD suggests that HTLV-1 is not a common trigger of acute attacks in patients with AQP4-Ab positive NMOSD in populations with high HTLV-1 seroprevalence.

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Mielopatias: considerações clínicas e aspectos etiológicos

Cited by 10 publications

References 18 publications

Epidemiological aspects in neuroschistosomiasis

Epidemiological aspects in neuroschistosomiasis

Transverse myelitis associated to HCV infection

Aquaporin-4 Antibodies Are Not Related to HTLV-1 Associated Myelopathy

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