ABSTRACT
A malária é a principal e a mais grave doença parasitária no mundo. A infecção pelo Plasmodium falciparum é capaz de afetar diretamente o sistema nervoso central, causando déficits cognitivos e comportamentais que caracterizam a malária cerebral (MC). A MC é uma complicação decorrente da malária grave sendo responsável pela maioria dos casos de incapacidade e óbito. A ocorrência de seqüelas cognitivas e comportamentais após tratamento da MC tem sido descrita, principalmente em crianças. Adultos e crianças apresentam diferenças nas manifestações clínicas resultantes da MC. Geralmente, as crianças cursam com um espectro maior de alterações e apresentam déficits em vários domínios cognitivos após o tratamento da doença. Apesar da sua relevância clínica, os mecanismos patogênicos envolvidos no desenvolvimento das seqüelas resultantes da MC permanecem pouco elucidados. O entendimento desses mecanismos é fundamental para elaboração de intervenções terapêuticas adequadas que atuem na prevenção desses transtornos.
Malaria is the main and most serious parasitic disease in the world. Plasmodium falciparum infection can affect directly the central nervoussystem leading to cognitive and behavioral impairment which characterize cerebral malaria (CM). CM is a complication of severe malaria beingresponsible for almost all disability and death. The occurrence of cognitive and behavioral impairment after treatment has been reported, especially in children. Adults and children have differences in clinical manifestations related to CM. In general, children tend to present a greater spectrum of symptoms and impairment in almost all domains of cognition after infection treatment. Despite of its clinical relevance, pathogenic mechanisms involved in the development of CM sequelae remain poorly understood. A better understanding of these mechanisms is essential for the elaboration of appropriate therapeutic interventions which may contribute to the prevention of CM sequelae.
Subject(s)
Humans , Child , Adult , Motor Neuron Disease/etiology , Brain Diseases/etiology , Malaria, Cerebral/complications , Malaria, Cerebral/diagnosis , Malaria, Cerebral/physiopathology , Parasitic Diseases , Plasmodium falciparum/pathogenicity , Cognition Disorders/etiologyABSTRACT
A Síndrome do Homem no Barril (SHB) faz referência a um quadro de paresia/plegia braquial bilateral que influencia na execução de funções relacionadas aos membros superiores, principalmente as que requerem movimentos de flexão e abdução. Desde sua descrição inicial, inúmeros casos foram relatados de pacientes com essa síndrome, cuja etiopatogenia difere daquela descrita inicialmente. Apresentamos 5 casos de SHB relacionados a doenças do neurônio motor e, discutimos, com base na literatura vigente, os achados do exame neurológico, prejuízosfuncionais e exames complementares. As mais frequentes causas de SHB são distúrbios vasculares cerebrais, cirurgias cardíaca e extracardíaca com demonstração de hipotensão arterial, metásteses cerebrais, e o envolvimento da ponte e medula espinhal cervical. O substrato fisiopatológico que se relaciona a SHB, em alguns casos, é incerto e merece atenção. Atentamos para a SHB em determinadas doenças do neurônio motor, principalmente nas Amiotrofias Espinhais Progressivas e na Esclerose Lateral Amiotrófica.
The Man-in-the-Barrel syndrome (MBS) makes reference to a picture of bilateral brachial weakness/paralysis, that influences the patients in the execution of functions related with the upper limbs, mainly those that require flexion and abduction movement. Since its initial description, several cases were reported of patients with this syndrome, whose etiology differs from the first one described. We present 5 cases of MBS related to motor neuron diseases, and discuss, based on the literature, the findings of the neurological examination, functional impairments and complementary exams. The most frequent causes of MBS are cerebral vascular disorders, cardiac and extracardiac surgeries with demonstration of arterial hypotension, cerebral metastases, pontine and spinal cord involvement. The pathophysiological substratum related to MBS, in some cases, is uncertain and deserves attention. We call the attention to MBS in some motor neuron disease, especially in Progressive Spinal Atrophy and Amyotrophic Lateral Sclerosis.
Subject(s)
Humans , Male , Middle Aged , Muscular Atrophy, Spinal/complications , Motor Neuron Disease/diagnosis , Motor Neuron Disease/etiology , Amyotrophic Lateral Sclerosis/complicationsABSTRACT
A clear association between seasonal outbreaks of a paralytic disease called konzo and toxic effects from consumption of insufficiently processed bitter cassava roots has been demonstrated in Bandundu region, Zaire. A community-based survey of 6764 inhabitants identified 110 live and 24 dead konzo-affected persons with a history of isolated non-progressive spastic paraparesis of abrupt onset. The start of these annual outbreaks of konzo in 1974 coincided with the completion of a new tarmac road to the capital, which facilitated the transport of cassava and made it the main cash crop. The extensive cassava sales encouraged the consumption by the peasant families of roots that had not been adequately processed; frequent acute cyanide intoxications resulted when the naturally occurring cyanogens in the roots were eaten. The disease mainly appeared in the dry season when there was high consumption of insufficiently processed cassava and the diet lacked supplementary foods with sulfur-containing amino acids which promote cyanide detoxification. These results, which confirm the earlier findings in East Africa, show that, owing to the high cyanide and low sulfur dietary intake, there is an increased risk of konzo outbreaks in cassava-growing areas during periods of adverse agro-economic changes