Paraparesia espástica progresiva idiopática HTLV-I seronegativa: estudio clínico y neurofisiológico de las manifestaciones sensitivas / HTLV-I seronegative idiopathic progressive spastic paraparesis: clinical and neurophysiological study of the sensory features

Background: HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a defined entity. However, there are many patients not well characterized with a similar clinical picture who are HTLV-I seronegative. Objective: Clinical and neurophysiological description of patients with HTLV-I seronegative idiopathic paraparesia. Patients and Methods: Seventeen patients (4 women and 13 men aged 24-67 years, average 52.3) were evaluated including clinical assessment, vibratory sensory analysis, quantitative somatosensory thermotest (QST), somatosensory evoked potentials (SSEPs), electromyography (EMG) and motor and sensory nerve conductions. Results: In addition to the spastic paraparesis, 3 (17.6 percent) patients had pseudobulbar symptoms. Ten (58.8 percent) patients had a spastic gait but could walk unaided, 6 (35.2 percent) needed support and 1 patient could not walk. Bladder dysfunction was found in 10 (58.8) patients and sensory symptoms in 7 (41.1 percent). There was mild distal impairment of vibration and position sense, distal tactile and pinprick hypoesthesia in 4 (23.4 percent) patients. Tibial SSEPs were abnormal in 11 (64.7 percent). Nerve conduction studies and EMG were normal. QST showed cold hypoesthesia in 14 (82.4 percent) patients. Warm sensation and heat pain appeared unimpaired. Conclusions: All sensory abnormalities found were restricted to sensations carried by myelinated (A beta and A delta) channels. Sensory and motor abnormalities are similar to HAM/TSP patients suggesting a common pathogenesis

Efecto del núcleo CMP forte en 46 pacientes con paraparesia espástica progresiva: estudio randomizado y ciego / Effect of CMP forte nucleus in 46 patients with progressive spastic paraparesis: randomized and blind study

Idiopatic or HTLV-1 associated progressive spastic paraparesis does not have a clear etiology or treatment. To assess the effects of a medication containing cytidinmonophosphate, uridintriphosphate and vitamin B 12 in the treatment of progressive spastic. Patients with the disease were randomly assigned to receive the Nucleus CMP forte (containing dysodic cytidinmonophosphate 5 mg,trisodic uridintriphosphate 3 mg and hydroxicobalamin 2 mg) tid or placebo during 6 months. Gait, spasticity, degree of neurogenic bladder and somatosensitive evoked potentials were assessed during treatment. Forty six patients aged 25 to 79 years old were studied, 24 were female and 29 HTLV-1 positive. Twenty two were treated with the drug and the rest with placebo. Gait and spasticity improved in 7 of 22 patients receiving the drug and 1 of 24 receiving placebo (p<0.05). Neurogenic bladder improved in 10 of 22 receiving the drug and 4 patients treated with the drug and in two of seven treated with placebo. The medication caused a modest improvement in patients with progressive spastic paraparesis and was free of side effects

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