Caracterización general de Zika / General characterization of Zika

El Zika es un arbovirosis que causa enfer-medad febril caracterizada por fiebre, rash, artralgias y conjuntivitis no purulenta. En 2015 se registraron casos autóctonos en Brasil, en menos de un año el Zika se exten-dió a más de 30 países y territorios de Améri-ca Central, América del Sur, el Caribe y México, entre estos Honduras. Se ha rela-cionado con aumento de los casos de Gui- llain Barré y microcefalia en zonas donde produce epidemia. En Honduras, entre la semana epidemiológica 1 del 2016 a la 33 del 2017, hubo un total acumulado de 681 mujeres embarazadas con sospecha de Zika identificadas en el país, 125 de las cuales han sido confirmadas en laboratorio por reacción en cadena de polimerasa. Se reali-zó una revisión bibliográfica de 30 artículos tomando como referencia: artículos de revis-tas, normas y recomendaciones menores de 5 años de haber sido publicados o aquellos con importancia histórica, con el fin de brin-dar información útil al lector acerca del tema. Zika es una enfermedad que puede generar un impacto negativo en la salud de la niñez, dejando secuelas a largo plazo...(AU)

Diplejía facial como variante inusual del síndrome de Guillain-Barré: primer caso reportado en Venezuela / Facial diplegia as unusual variant of Guillain-Barré syndrome: first case reported in Venezuela

El síndrome de Guillain-Barré (SGB) es la causa más común de parálisis generalizada aguda. El SGB es una polirradiculoneuropatia aguda inflamatoria desmielinizante que generalmente se presenta como una parálisis que inicia en miembros inferiores y luego progresa de forma ascendente y simétrica. El presente trabajo, tiene como objetivo, informar un caso de diplejía facial como manifestación inicial de SGB. Paciente masculino, 37 años de edad, diabético tipo 2, que luego de ocho días de haber padecido una sinusitis aguda, presentó de forma gradual, cefalea hemicraneana derecha, derramamiento salival y disartria. En la exploración neurológica se observó ausencia bilateral de los pliegues frontales, lagoftalmos bilateral acompañado de epífora, signo de Bell bilateral y derramamiento salival a través de ambas comisuras labiales. A las 48 horas de su ingreso hospitalario, presentó paresia en ambos miembros superiores. El estudio del líquido cefalorraquídeo reportó 1,1 células/mm³ representadas en su totalidad por linfocitos de aspecto normal, y proteínas totales 196,9mg/dL. La electromiografía fue compatible con polineuropatía desmielinizante aguda de predominio motor con mayor afectación facial. Con los hallazgos clínicos y paraclínicos se realizó el diagnóstico de SGB. Se inició tratamiento a base de plasmaféresis e inmunoglobulina endovenosa, con posterior mejoría de la clínica. La diplejía facial forma parte de las variantes regionales del SGB. A pesar que cerca del 60% de los pacientes con SGB presentan debilidad facial en el curso del trastorno, ésta habitualmente es precedida por debilidad en extremidades. El presente caso permite evidenciar que el SGB puede debutar clínicamente como una diplejía facial.

The Guillain-Barré syndrome (GBS) is the most common cause of acute generalized paralysis. GBS is an acute inflammatory demyelinating polyradiculoneuropathy. It usually presents as a paralysis that starts in the lower limbs and then progresses symmetrically upward. The present study reports a case of bilateral facial palsy as the initial manifestation of GBS. This is a report of a case of a 37-year-old male, diabetic, that eight days after having suffered acute sinusitis, gradually presented with right hemicranial headache, dysarthria and sialorrhea. The neurological examination disclosed the absence of the bilateral frontal folds, accompanied by epiphora, bilateral lagophthalmos, bilateral Bell sign and salivary drooling through both commissures of lips. At 48 hours after hospital admission the patient showed paresis in both upper limbs. The cerebrospinal fluid analysis reported 1.1cells/mm³, fully represented by lymphocytes of normal aspect and total proteins were 196.9 mg/dL. The electromyography was consistent with acute demyelinating polyneuropathy, with a predominant motor component and a major facial involvement. With the clinical and laboratory findings, a diagnosis of GBS was established. Treatment was started with plasmapheresis and intravenous immunoglobulin, with the subsequent improvement of the clinic. The facial diplegia is part of the regional variants of GBS. Although about 60% of GBS patients present with facial weakness, it is usually preceded by weakness in the limbs. This case makes evident that GBS may present clinically as a facial diplegia.

Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome in a patient with Thalassemia intermedia

Here, we present the first instance of Guillain-Barr‚ syndrome variant in a patient with beta thalassemia and iron overload who had a history of transfusion before the onset of symptoms. Our patient was a 50- year-old Persian woman with history of intermediate thalassemia who had been treated with pack cells because of low hemoglobin level. Ten days after transfusion, she developed numbness of arms, left sided ptosis, and afterwards dysarthria, dysphagia, and bilateral ptosis. Electrodiagnosis on day 12 revealed reduced repetition of f-waves in the upper limbs and reduced recruitment with 1+ fibrillation in facial muscles. Electromyography and nerve conduction velocities in the limbs were normal. After excluding other causes and according to electrodiagnosis, the pharyngeal-cervical-brachial variant of Guillain- Barre syndrome was considered and plasma exchange began. Following exchanges, significant clinical improvement was attained. Iron overload and possible transmission of infections from blood products might have contributed in the development of syndrome

Guillian Barré syndrome--recent advances.

Guillian Barré Syndrome (GBS) is an acquired disease of the peripheral nerves that is characterized clinically by rapidly progressing paralysis, areflexia, and albumino-cytological dissociation. It affects both genders, involves people of all ages, is reported worldwide, and in the post-polio era, it is the most common cause of an acute generalized paralysis. The clinical features are distinct and a history and an examination generally lead to a high suspicion of the diagnosis that can then be confirmed by supportive laboratory tests and electrodiagnostic studies. This review discusses the recent advances in understanding of the different variants of GBS such as acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), and the Fisher syndrome. The clinical, electrodiagnostic criteria, immunopathogenesis, and management of GBS and its variants are discussed.