ABSTRACT
O diabetes e suas complicações constituem as principais causas de mortalidade precoce na maioria dos países. O envelhecimento da população e a crescente prevalência da obesidade e do sedentarismo, além dos processos de urbanização, são considerados os principais fatores responsáveis pelo aumento da incidência e da prevalência do diabetes mellitus (DM) em todo o mundo. Este relato de caso objetiva descrever a presença de distúrbio do movimento em idoso por conta do estado hiperosmolar não cetótico. A combinação de hemicoreia-hemibalismo, hiperglicemia não cetótica e envolvimento dos gânglios da base em exames de imagem é considerada uma síndrome única. Os distúrbios do movimento em estado hiperosmolar não cetótico apresentam resposta terapêutica satisfatória com o uso de neurolépticos e controle glicêmico adequado. A escassez de trabalhos publicados proporciona subdiagnósticos clínico e laboratorial, interferindo no prognóstico e no acompanhamento dos pacientes.
Diabetes mellitus (DM) and its complications constitute the leading causes of early mortality in most countries. Population aging and the growing prevalence of obesity and sedentary lifestyles, in addition to spreading urbanization, are considered the main drivers of the increasing incidence and prevalence of DM worldwide. This case report describes the acute onset of movement disorder in an older woman secondary to hyperosmolar hyperglycemic state (HHS). The combination of hemichoreahemiballismus, HHS, and evidence of basal ganglia involvement on neuroimaging is considered a unique syndrome. Movement disorders secondary to HHS respond satisfactorily to administration of neuroleptic agents and proper glycemic control. The lack of published studies on this pathologic entity may lead to clinical and laboratory underdiagnosis, with negative impacts on patient prognosis and follow-up.
Subject(s)
Humans , Female , Aged , Chorea/drug therapy , Chorea/diagnostic imaging , Hyperglycinemia, Nonketotic/complications , Dyskinesias/drug therapy , Dyskinesias/diagnostic imaging , Diabetes Complications , Psychotropic Drugs/therapeutic use , Diabetes Mellitus/physiopathology , Hypoglycemic Agents , Movement Disorders/diagnosisABSTRACT
Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle associated proteins responsible for acetylcholine release into the neuromuscular junction. As a military or terrorist weapon, botulinum toxin could be disseminated via aerosol or by contamination of water or food supplies, causing widespread casualties. A fascinating aspect of botulinum toxin research in recent years has been development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for treatment of human diseases. In the late 1980s, Canada approved use of the toxin to treat strabismus, in 2001 in the removal of facial wrinkles and in 2002, the FDA in the United States followed suit. The present review focuses on both warfare potential and medical uses of botulinum neurotoxin.
Subject(s)
Biological Warfare Agents , Botulinum Toxins/antagonists & inhibitors , Botulinum Toxins/genetics , Botulinum Toxins/pharmacology , Botulinum Toxins/toxicity , Botulism/epidemiology , Botulism/physiopathology , Botulism/prevention & control , Clostridium botulinum/chemistry , Dyskinesias/drug therapy , Humans , Spasm/drug therapy , Strabismus/drug therapyABSTRACT
Hemiballism is an uncommon neurological disorder characterized by uncontrollable movements of one lateral half of the body. We report a 56 years old male with a history of three weeks of polydipsia, polyuria and weight loss that, three days before consultation, started with hemiballism. A CAT scan without contrast showed a higher density in the lenticular nucleus and calcifications in caudate and lenticular nuclei. Diabetes was treated with regular insulin and hemiballism was controlled with neruoleptics. Ten days after admission a new CAT scan shows a partial regression of the lenticular lesion. After two months of follow up, the patient is asymptomatic.
Subject(s)
Humans , Male , Middle Aged , Diabetes Mellitus/physiopathology , Dyskinesias/etiology , Hyperglycemia/complications , Anti-Dyskinesia Agents/therapeutic use , Diabetes Mellitus/diagnosis , Dyskinesias/diagnosis , Dyskinesias/drug therapy , Hypoglycemic Agents , Haloperidol/therapeutic use , Hyperglycemia/drug therapy , Treatment OutcomeABSTRACT
In recent years there has been a growing interest towards pediatric movement disorders (PMD). The data derived from the synthesis of clinical observation, neuroimaging, biochemical and, molecular genetics studies have allowed for the identification of a significant number of pediatric diseases featuring movement disorders. The purpose of this review is to outline an approach to the advances in management of dystonia, neurotransmitter disorders, tics, and paroxysmal dyskinetic syndromes starting in children younger than 18 yr of age.
Subject(s)
Age Distribution , Age of Onset , Baclofen/therapeutic use , Benzodiazepines/therapeutic use , Child , Child, Preschool , Cholinergic Antagonists/therapeutic use , Dopamine Agents/therapeutic use , Drug Therapy, Combination , Dyskinesias/diagnosis , Dyskinesias/drug therapy , Dyskinesias/epidemiology , Early Diagnosis , Electromyography , Female , Humans , Incidence , Infant , Levodopa/therapeutic use , Male , Movement Disorders/diagnosis , Movement Disorders/drug therapy , Movement Disorders/epidemiology , Physical Examination , Prognosis , Risk Assessment , Severity of Illness Index , Sex Distribution , Spain , Treatment OutcomeABSTRACT
Desde la introducción de la levodopa para el manejo de la enfermedad de Parkinson ésta ha sido el tratamiento estándar de esta enfermedad. La aparición de fármacos alternativos como los agonistas dopaminérgicos abrieron un debate acerca de los potenciales beneficios de estas terapias por sobre levodopa y los eventuales efectos deletéreos de esta última. En este artículo se actualiza la información acerca de las complicaciones motoras y de neurotoxicidad inducidas por levodopa.
Subject(s)
Humans , Parkinson Disease/drug therapy , Levodopa/toxicity , Motor Skills Disorders/etiology , Antiparkinson Agents/toxicity , Nerve Degeneration/chemically induced , Dyskinesia, Drug-Induced/etiology , Dyskinesias/drug therapyABSTRACT
Relatamos oito casos de hemibalismo: seis em pacientes com diabetes mellitus; um em paciente com encefalomalácia pós trauma crânio-encefálico; e um em paciente com granuloma fúngico (criptococo) subtalâmico associado a SIDA. Entre os pacientes com diabetes mellitus, três apresentavam hiperglicemia nao cetótica, dois dos quais com hemorragias nos gânglios da base, e três acidente vascular encefálico isquêmico. Em 75 por cento dos casos ocorria também hemicoréia, com acometimento predominante do dimídio direito. Do total de pacientes seis apresentaram boa resposta clínica ao tratamento farmacológico com neurolépticos. Dois pacientes foram submetidos a talamotomia estereotáxica, um dos quais apresentou remissao completa do hemibalismo. Em nossa série de oito pacientes com hemibalismo houve predominância da associaçao com diabetes mellitus e acidente vascular encefálico, e boa evoluçao clínica