ABSTRACT
Resumen ANTECEDENTES: la encefalopatía de Wernicke se origina por el déficit de vitamina B1 y sus características sobresalientes son: triada de confusión, ataxia y oftalmoplejia. Cuando hay déficit de memoria o aprendizaje se denomina síndrome de Wernicke-Korsakoff. CASO CLÍNICO: se comunica el caso de una paciente en su primer embarazo, de 18 semanas de gestación, con varios ingresos al hospital por hiperemesis gravídica; acudió al servicio de Urgencias por un cuadro de pérdida progresiva de fuerza en las extremidades inferiores. A los cinco días del ingreso tuvo empeoramiento del estado general. A la exploración física se identificó nistagmus horizonto-rotatorio, bilateral, espontáneo, tetraparesia flácida de predominio proximal, con arreflexia global de predominio en EEII y pérdida de tono de los esfínteres. La paciente se encontraba confusa, desorientada y repetitiva en su discurso. Se inició tratamiento con tiamina parenteral, por sospecha de polineuropatía metabólica por déficit de tiamina; el nistagmus y el cuadro de confusión disminuyeron. Un mes más tarde se programó para tratamiento intensivo de rehabilitación. La evolución del embarazo trascurrió con normalidad y continuó en tratamiento con tiamina y antieméticos, con estabilidad y control del cuadro. CONCLUSIÓN: la encefalopatía de Wernicke es una padecimiento de frecuencia excepcional, pero de consecuencias muy graves; de ahí la importancia de tenerlo en mente en pacientes embarazadas susceptibles de padecerlo y poner en práctica las medidas de profilaxis adecuada que eviten su aparición y las secuelas.
Abstract BACKGROUND: Wernicke's encephalopathy, caused by vitamin B1 deficiency, is characterised by the triad of confusion, ataxia and ophthalmoplegia. If memory or learning deficits appear simultaneously, it is known as Wernicke-Korsakoff syndrome. CLINICAL CASE: We present the case of a primigravida in her 18th week of pregnancy who had been suffering from hyperemesis gravidarum. She came to the emergency unit because of progressive loss of strength in her lower limbs. Five days after her admission, a deterioration of her general condition was observed. The examination revealed bilateral spontaneous horizontal-rotatory nystagmus, flaccid tetraparesis with proximal predominance, global areflexia predominantly in the lower limbs and loss of sphincters tone. The patient was confused, disoriented and repetitive in her speech. Parenteral vitamin B1 was initiated as a metabolic polineuropathy due to thiamine insufficiency was suspected. As a result the symptoms of nystagmus and confusion subsided. Intensive physical therapy was programmed in a rehabilitation unit 1 month later. Pregnancy developed normally and she continued with thiamine and antiemetic therapy. CONCLUSIONS: Wernicke's encephalopathy is an infrequent pathology, but its consequences may be really serious. This is the reason why it is paramount to take into account this entity in pregnant women liable to develop it and to carry out adequate prophylaxis to prevent its appearance and development of posterior sequels.
ABSTRACT
This study was conducted to evaluate new acupuncture protocols for the clinical treatment of cervical spinal cord diseases in 19 dogs. Three treatment options containing Jing-jiaji (cervical jiaji) were developed to treat neck pain, hemiparesis, and tetraparesis depending on the severity. The interval between the neurological disease onset and treatment (duration of signs), time to improvement after treatment, and recovery time were compared in dogs by body weight, age, and dry needle acupuncture (AP) with or without electro-AP (EAP). The duration of signs was longer in dogs weighing greater than 10 kg than in those weighing less than 10 kg (p < 0.05). Improvement and recovery times did not vary by body weight. Additionally, improvement and recovery times did not vary by age. The improvement and recovery times were longer in the AP+EAP group than the AP group (p < 0.05). Acupuncture with Jing-jiaji was effective in cervical spinal cord diseases in different sized dogs and in middle-aged and senior dogs. This report standardized AP treatment containing Jing-jiaji for canine cervical problems and evaluated its effects. The newly standardized AP methodology offers clinical practitioners an effective way to improve the outcomes of cervical neurological diseases in dogs.
Subject(s)
Animals , Dogs , Acupuncture , Body Weight , Cervical Cord , Neck Pain , Needles , Paresis , Retrospective StudiesABSTRACT
The involvement of the Peripheral Nervous System (PNS) occurs in a small proportion of patients with vasculitis. In our case report, the patient appears with a sensory-motor polyneuropathy, manifestation of a systemic vasculitis, which involved only the vasa nervorum.
El compromiso del Sistema Nervioso Periférico (SNP) ocurre en una pequeña proporción de pacientes afectados por vasculitis. En nuestro caso clínico, la paciente en cuestión debuta con una polineuropatía sensitivo-motora, manifestación de una vasculitis sistémica que comprometía sólo la vasa nervorum.