Hiperactividad simpática paroxística: una entidad subdiagnosticada: caso clínico / Paroxysmal sympathetic hyperactivity: report of one case

Paroxysmal sympathetic hyperactivity may appear after brain injury. Its clinical manifestations are sporadic and self-limited crisis of arterial hypertension, hyperthermia, tachycardia, hyperhidrosis, muscle tension, sialorrhea and mydriasis. These subside with the administration of morphine and beta-blockers. It may be caused by a dysautonomia leading to increased levels of catecholamines due to the lack of brain regulation. We report a 19 years-old man with a history of illicit drug and alcohol consumption, with a secondary axonal injury due to a cranioencephalic trauma. During hospitalization, he had recurrent, self-limited episodes of dysautonomia. An infectious cause was discarded. When morphine was administrated suspecting the presence of pain, the crisis subsided, which helped to establish the diagnosis of paroxysmal sympathetic hyperactivity.

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits / Avaliação do dano causado pela clipagem ou secção do nervo simpático cervical em coelhos

PURPOSE: To study the macro and microscopic evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits, quantifying the collagen in the lesions. METHODS: Twenty rabbits were divided into two groups of ten, doing in group 1 (section) section of the right cervical sympathetic nerve, while in group 2 (clipping) clipping of the nerve. All rabbits were induced to death on the seventh day after surgery. The macroscopic variables were: consequences of nerve lesion, clip appearance, presence of infection and adhesions around the nerve. Microscopy used hematoxylin-eosin staining to evaluate the stages and the degree of inflammation and necrosis, and F3BA Picrosirius red staining to quantify collagen. Mann-Whitney test was used for comparisons of collagen types I and III between groups. Fisher exact test analyzed the macroscopic variables, the degree of inflammation and necrosis. RESULTS: There was no discontinuity of nerve injury in the clipping group, as well as the clip was closed in all animals. The presence of severe adhesions was significantly higher in the clipping group (p<0.05). There was no significant difference on other variables macroscopically analyzed. There was no significant difference between groups regarding the type of inflammatory process and its intensity, as well as the presence of necrosis and collagen deposition in the nerves. CONCLUSIONS: In the macroscopic evaluation, the section caused discontinuity, which did not occur in the clamping group; there was no development of local infection; the clipping of the cervical sympathetic nerve was linked to the presence of a greater number of adhesions in comparison to the section group. Microscopically, no difference existed in relation to the type and intensity of inflammation reaction between the groups; occurred predominance of chronic and severe inflammation on the specimens; the necrosis was noticed equally in both groups; there was predominance of type I collagen deposition in relation to type III in both groups.

OBJETIVO: Estudar a lesão provocada pela secção e pela clipagem no nervo simpático cervical de coelhos, avaliando-se a macroscopia, microscopia e quantificando-se o colágeno nas lesões. MÉTODOS: Foram utilizados 20 coelhos, distribuídos em dois grupos de dez, sendo nos animais do grupo 1 (secção) realizada secção do nervo simpático cervical direito, enquanto nos do grupo 2 (clipagem) realizada a clipagem desse nervo. Todos os coelhos foram induzidos à morte no sétimo dia de pós-operatório. As variáveis macroscópicas avaliadas foram: presença de lesão de descontinuidade do nervo, aspecto do clipe, presença de infecção e de aderências ao redor do nervo. A microscopia com hematoxilina-eosina foi feita para avaliar as fases, o grau do processo inflamatório e a presença de necrose; a coloração de Picrosirius red F3BA quantificou o colágeno. Utilizou-se o teste de Mann-Whitney nas comparações dos colágenos tipo I e tipo III entre os grupos. As variáveis macroscópicas, o grau do processo inflamatório e presença de necrose foram analisadas pelo teste de Fisher. RESULTADOS: Não houve lesão de descontinuidade do nervo no grupo clipagem, assim como o clipe encontrou-se fechado em todos os animais desse grupo. A presença de aderências intensas foi significativamente maior no grupo clipagem (p<0,05). Não houve diferença significativa quanto às demais variáveis analisadas macroscopicamente. Não houve diferença significativa entre os grupos quanto ao tipo de processo inflamatório e sua intensidade, assim como quanto à presença de necrose e ao depósito de colágeno nos nervos. CONCLUSÕES: Na avaliação macroscópica, a secção causou lesão de descontinuidade, o que não ocorreu na clipagem; não houve desenvolvimento de infecção local; a clipagem do nervo simpático cervical foi associada à presença de maior quantidade de aderências em relação à secção. Na avaliação microscópica reconheceu-se não haver diferença no tipo e na intensidade do processo inflamatório entre os grupos; ocorreu predomínio de processo inflamatório crônico e acentuado; as necroses ocorreram igualmente em ambos os grupos; houve predomínio de depósito de colágeno tipo I em relação ao tipo III em ambos os grupos.

Denervación simpática de una extremidad como forma de presentación en cáncer del vértice pulmonar / Sympathetic denervation of an upper limb as a presentation form of an apical lung cancer

We report a 56 years old male patient presenting with a sympathetic denervation of the right upper limb due to an apical lung cancer. Vasomotor paralysis of the limb was objectively documented with a contact termography. The clinical presentation of this patient was unusual, considering that the alteration occurred without sensory or motor changes of the limb or autonomic disturbances of the face. The absence of clinical and neurophysiological involvement of large and small caliber fibres of the brachial plexus and the lack of autonomic dysfunction of the face was explained by a predominant tumoral infiltration of T2 and T4 ventral roots, wich supply autonomic innervation to the upper limbs

[Many localisations of ganglioneuroma: about of one case]

Ganglioneuroma and neuroblastoma are both tumors of the sympathetic nervous system. Neuroblastoma is a malignant tumor, but ganglioneuroma is a benign and a mature one. The study deals with an uncommun aspect of the ganglioneuroma which is revealed by multiple cutaneous metastasis. Examination revealed two others mediastinal and retroperitoneal tumors which are asymtomatic. We think, as the majority of investigators that the tumor was previously a neuroblastoma that metastased at the skin and matured of ganglioneuroma with primary and metastatic tumor. Surgical treatment of both mediastinal and retroperitoneal tumors had led by itself to a regression of subcutaneous with the tumors mentioned above

Sindrome de hiperactividad simpática en el tétanos: su tratamiento con alfa y beta bloqueantes / Sympathetic hyperactivity syndrome in the tetanus: its treatment with alpha and beta blockaders

Para describir los rasgos clínicos del Síndrome de Hiperactividad Simpática (S.H.S.) y los resultados obtenidos por la terapéutica alfa y beta bloqueante y destacar la importancia del control del S.H.S., se estudiaron 10 (diez) casos de tétanos internados en nuestra Unidad desde junio de 1979 hasta junio de 1981. Presentaron S.H.S. siete pacientes. Siguiendo normas del Servicio todos los pacientes recibieron tratamiento básico y de acuerdo con la severidad, tratamiento sintomático. Cuatro pacientes recibieron clorpromazina 100-150 mg/día (bloqueo alfa), los tres restantes recibieron, además de clorpromazina en iguales dosis, propanolol, 60-120 mg/día (bloqueo beta). Los siete pacientes con S.H.S. eran tétanos graves. Los 4 pacientes tratados con bloqueo alfa exclusivo fallecieron, tres por disturbios hemodinámicos incontrolables y uno por falla en la asistencia respiratoria mecánica. De los tres casos tratados con alfa y beta bloqueantes sólo uno falleció (distress pulmonar), pudiéndose controlar en él las manifestaciones de S.H.S. que habían aparecido. No obstante la pequeña población estudiada, podemos concluir, que: el bloqueo alfa exclusivo no brindó resultados favorables en lo que hace a la sobrevida. La adición del bloqueo beta al tratamiento en caso de evidencia de S.H.S. puede brindar una disminución de la mortalidad que el síndrome acarrea