Trastorno del procesamiento sensorial. Una mirada conjunta desde la terapia ocupacional y la otorrinolaringología / Sensory processing disorder. A vision statement from occupational therapy and otolaryngology

Resumen El trastorno del procesamiento sensorial (TPS) es una condición frecuente, pero poco conocida por muchos profesionales de la salud. El procesamiento sensorial se define como la capacidad que posee el sistema nervioso central de interpretar y organizar las sensaciones del propio cuerpo y del ambiente, para su uso efectivo en el entorno mediante respuestas adaptativas. Por lo tanto, cualquier disfunción en el procesamiento (registro, modulación y/o discriminación) de estos estímulos se expresa como una respuesta desadaptativa, siendo significativo cuando esta impacta en la vida diaria del paciente. Es deber del médico sospechar este trastorno, acogiendo al paciente y su familia, derivando oportunamente a terapia ocupacional para su correcta evaluación y eventual manejo de acuerdo con las necesidades de cada paciente.

Abstract Sensory processing disorder (SPD) is an unknown condition for many health care professionals. Sensory processing is defined as the capacity of the central nervous system to interpretate and organize sensations from our own body and from the environment, for their proper use by adaptive responses. Any dysfunction in this processing (registration, modulation and or discrimination) is expressed by a maladaptive response, being considered abnormal when this response has a negative impact in the patient's daily activities. Is our duty as health care workers to suspect this disorder, help our patients and their families by doing a proper referral to an occupational therapist for their evaluation and management, according to each patient needs.

Cuestionario de proceso sensorial en adultos: comparación de resultados entre población de USA y de Chile: resultados preliminares / Sensory proccesing questionaire in adults: comparation of results between USA and Chile population: preliminary results

Existen escasos estudios sobre la forma de evaluar el proceso sensorial en adultos; una de estas formas es el uso de perfil sensorial desarrollado por Brown y Dunn en el año 2002, aplicable tanto para la población infantil como adulta de habla inglesa. Hasta el momento no existe una evaluación de procesamiento sensorial del adulto validada en castellano. En base a estos antecedentes, el principal objetivo de este estudio es validar la construcción interna de una escala de procesamiento sensorial en el adulto a través del Cuestionario del Proceso Sensorial del Adulto (CPSA) con una población de habla hispana, para luego comparar los resultados con la misma prueba anteriormente valorada en una población de habla inglesa. Los pasos en la elaboración de esta prueba fueron los siguientes: 1) traducción de la prueba al castellano; 2) instalación de la prueba en Internet e invitación a responderla; 3) análisis de los resultados usando estadísticas descriptivas y análisis de factores para observar diferencias con los factores desarrollados con las personas de habla inglesa y 4) comparación entre los factores obtenidos en la prueba con población hispana y con población de habla inglesa. Se dieron 11 factores que representan hipo o hiper respuesta en los sistemas sensoriales analizados. Estos factores se asemejan a los factores obtenidos con la población de habla inglesa. Esta prueba puede utilizarse para pesquisar dificultades de procesamiento sensorial de adultos en base a los resultados obtenidos.

There are many ways to evaluate sensory processing in children, but less so in adults. One of these evaluations is the Sensory Profile initially developed in children (Dunn, 1999; 2014) and also in adults (Brown & Dunn, 2002). These tests were developed in English and until this point, there are no assessments of sensory processing validated with Spanish – speaking adults. The main objective of this study is to validate the internal construction of the Adult Sensory Processing Questionnaire Adult Sensory Processing (ASPS) with a Spanish-speaking population, and compare the results with the same test previously validated with an English-speaking (Blanche, Parham, Chang & Mallinson, 2014). The steps in the development of this test were as follows: 1) translation of original version to Spanish; 2) test upload and invitations to potential responders; 3) analysis of the results using descriptive statistics and factor analysis to evaluate the factor differences between the English and Spanish answers; and 4) comparison between the factors obtained in the test with Spanish and English speaking population. The factor analysis yielded 11 factors representing hypo or hyper response in sensory systems. These factors are similar to the factors obtained with the English-speaking population. This test may be used in order to screen sensory processing difficulties adult based on the results.

Desórdenes de la modulación sensorial y dibujo de la figura humana / Sensory modulation disorder and human figure drawing

El propósito de éste trabajo es examinar las características del dibujo de la figura humana (DFH) en niños con desórdenes en la modulación sensorial (DMS), establecer si hay diferencias significativas respecto a los niños de desarrollo típico e identificar en que dimensiones se observan estas diferencias: cuantitativas (diferente número de partes) cualitativas (claras desproporciones, agregados u omisiones) o ambas. Para ello se administró el DFH a veintiún niños de 4.9 a 5.8 años de edad, que obtuvieron un resultado de dos desviaciones estándar por debajo de la norma en el Perfil Sensorial Forma Corta (versión en español) de McIntosh, Miller, Syu & Dunn (1999), de escuelas de gestión pública o privada de la ciudad autónoma de Buenos Aires y provincia de Buenos Aires, y se compararon con veintiún niños de similar edad y escolaridad, que obtuvieron un resultado dentro del rango típico en este instrumento. El Perfil Sensorial fue usado como herramienta para discriminar los niños con y sin DMS. Mientras que los DFH se analizaron usando el Miller Assessment for Preschoolers (MAP 1982,1988) sub-test de la figura humana. Los resultados obtenidos confirman la hipótesis planteada. Los niños con DMS realizaron un DFH con un menor número de partes (p = <0.0005) e indicadores cualitativos indeseables. La relevancia del proyecto es indicar al DFH como una herramientas de observación estructurada del niño, dentro del marco holístico propio del quehacer clínico del terapista ocupacional. Y contribuir al conocimiento del impacto de los DMS en el desempeño ocupacional del niño.

The purpose of this study is to examine the characteristics of human figure drawing (HFD) in children with sensory modulation disorders (SMD) establishing whether there are significant differences relative to typically developing children, and to identify in which dimensions those differences are observed: quantitative (different number of parts) qualitative (clear disproportions, aggregates or omission) or both. For that a HFD was administered to twenty one children between the ages of 4.9 and 5.8 years of age, from public or private schools of the Autonomus city of Buenos Aires and the province of Buenos Aires, who obtained a score of two standard deviation below the norm in the Sensory Profile Short Form (Spanish version) of McIntosh, Miller, Syu & Dunn (1999) and were compared with twenty one children of similar age and education who received a score within the typical range on this test instrument.The Sensory Profile was used as a tool to discriminate children with and without SMD.While the HFD were analyzed using the Miller Assessment for Preschoolers (MAP, 1982, 1988) sub-test of the Humane Figure. The results obtained, confirmed the stated hypothesis. The children with SMD produced a HFD with less number of parts (p= <0.0005) and undesirable qualitative features. The relevance of this project is to indicate that HFD could be a tool for the structured observation of the child used by occupational therapist within the context of their holistic framework. And contribute to the knowledge of the impact of SMD in the occupational performance of the child.

El desarrollo de un cuestionario para padres para la medición de la responsividad sensorial en niños con diagnóstico de autismo (CMRS) / The development of a parental questionnaire to measure sensory responsivity in children with a diagnosis of autism (QMSR)

Este estudio presenta el desarrollo de un Cuestionario para Padres para la Medición de la Responsividad Sensorial en Niños con Diagnóstico de Autismo (CMRS). Se llevaron a cabo una revisión sistemática de la literatura internacional en el período 2000-2015 y tres estudios Delphi. Los estudios Delphi examinaron prospectivamente a ochenta y siete (N=87), setenta y tres (N= 73) y sesenta (N= 60) Terapeutas Ocupacionales certificados en Integración Sensorial en Argentina. Los profesionales clasificaron 62 ítems en los rótulos de “mantener”, “modificar” o “eliminar” los ítems del CMRS y proporcionaron cambios en su estructura y redacción. Adicionalmente, determinaron su inclusión en cuatro categorías: “hipo-responsividad”, “hiperresponsividad”, “planificación motriz” y “social” y dentro de seis escalas de responsividad sensorial: “visual”, “auditiva”, “vestibular”, “gusto/olfato”, “propioceptiva” y “táctil”. Se presenta la versión final del CMRS y la retroalimentación profesional en todos sus ítems, categorías y escalas así como también sugerencias para estudios futuros que podrían proporcionar información adicional para su aplicación clínica y en investigación.

This study presents the development of a Parental Questionnaire for the Measurement of Sensory Responsivity in Children with a Diagnosis of Autism (QMSR). A systematic review of the international literature in the 2000-2015 period and three Delphi studies were conducted. The three Dephi studies prospectively examined eighty-seven (N=87), seventy-three (N=73) and sixty (N=60) Argentine Occupational Therapists certified in Sensory Integration. These professionals classified all 62 items of the QMSR with three labels that included “maintain” “modify” and “eliminate” and provided written suggestions for changes in their structure and composition. Additionally, they determined their inclusion in four categories: “Hypo-responsivity”, “Hyper-responsivity”, “Motor Planning” and “Social” and six sensory responsivity scales: “Visual”, “Auditory”, “Vestibular”, “Taste/Smell”, “Proprioceptive” and “Tactile”. The final version of the QMRS and professional feedback on all its items, categories and scales is presented, together with suggestions for future studies that could potentially clarify its clinical utility and research applications.

Avaliação do equilíbrio em idosos que sofrem queda e aqueles que não sofrem quedas / Evaluation of balance in fallers and non-fallers elderly

Quedas representam um importante problema de saúde entre a população idosa. Aproximadamente um terço dos idosos acima de 65 anos de idade sofrerão uma ou mais quedas por ano. OBJETIVO: Avaliar o equilíbrio entre idosos que caem e aqueles que não sofrem queda. Desenho do estudo: clínico. MÉTODOS: Investigamos 30 indivíduos com mais de 65 anos de idade. 15 haviam sofrido queda em um período de um ano (Grupo I) e 15 não tinham passado de quedas (Grupo II). Comparamos os valores da Posturografia Dinâmica Computadorizada (PDC); Teste de Organização Sensorial (TOS); Limites de Estabilidade (LE); Deslocamento Ponderal Rítmico (DPR) e Escala de Equilíbrio de Berg (EEB) entre os indivíduos dos grupos I e II. RESULTADOS: Os valores de TOS 3, 6 e composto, EEB e escore de velocidade no eixo direita-esquerda do DPR foram significativamente menores no Grupo I e determinamos o TOS 4, 5, 6, composto e EEB do grupo II (p < 0,05). CONCLUSÃO: Os valores de PDC e EEB em idosos que sofrem quedas estiveram significativamente mais baixos quando comparados àqueles que não caíram.

Falls present a substantial health problem among the elderly population. Approximately one-third of community-dwelling people over 65 years of age will experience one or more each year. OBJECTIVE: The purpose of this study was to evaluate balance between fallers and non-fallers elderly. Study Design: Clinical study. METHODS: We studied 30 subjects older than 65 years of age. 15 subjects had a history of falls within a year (Group I) and 15 subjects had no history of falls (Group II). The scores of Computerized Dynamic Posturography (CDP); Sensory Organization Test (SOT), Limits of Stability (LOS), Rhytmic Weight Shift (RWS) and Berg Balance Scale (BBS) findings gathered from the individuals from Group I and Group II, were compared. RESULTS: The SOT 3, 6, composite, BBS scores and left-right on-axis velocity score of RWS test of the Group I were found to be significantly lower the Group II (p < 0.05). A positive correlation between the SOT 3, 5, composite and BBS scores of Group I and the SOT 4, 5, 6, composite and BBS scores of Group II is determined (p < 0.05). CONCLUSION: The CDP and BBS scores in fallers were found to be significiantly lower as compared to the non-fallers elderly.

Association between functional alterations of senescence and senility and disorders of gait and balance

OBJECTIVES: Declines in cognition and mobility are frequently observed in the elderly, and it has been suggested that the appearance of gait disorders in older individuals may constitute a marker of cognitive decline that precedes significant findings in functional performance screening tests. This study sought to evaluate the relationship between functional capacities and gait and balance in an elderly community monitored by the Preventive and Integrated Care Unit of the Hospital Adventista Silvestre in Rio de Janeiro, RJ, Brazil. METHODS: Elderly individuals (193 females and 90 males) were submitted to a broad geriatric evaluation, which included the following tests: 1) a performance-oriented mobility assessment (POMA) to evaluate gait; 2) a mini-mental state examination (MMSE); 3) the use of Katz and Lawton scales to assess functional capacity; 4) the application of the geriatric depression scale (GDS); and 5) a mini-nutritional assessment (MNA) scale. RESULTS: Reductions in MMSE, Katz and Lawton scores were associated with reductions in POMA scores, and we also observed that significant reductions in POMA scores were present in persons for whom the MMSE and Katz scores did not clearly indicate cognitive dysfunction. We also demonstrated that a decline in the scores obtained with the GDS and MNA scales was associated with a decline in the POMA scores. CONCLUSIONS: Considering that significant alterations in the POMA scores were observed prior to the identification of significant alterations in cognitive capacity using either the MMSE or the Katz systems, a prospective study seems warranted to assess the predictive capacity of POMA scores regarding the associated decline in functional capacity.

[Determining optimal clinical measurement tools for early detection of people at risk of falling]

Balance is defined as the process that maintains the center of gravity within the body's base of support and requires constant adjustments that are provided by muscular activity and joint positioning. The aim of the present study was to determine the best clinical measuring tools of balance in comparison to laboratory tools. In a cross-sectional study, 60 persons [one half in 20-40 and the other in 60-75 year old group] with the ability of standing and walking at least 7 meters and without any chronic diseases were evaluated by Biodex system, Berg Balance Scale, Functional Reach Test, Timed Up and Go Test and Lunge Test. Data analysis was indicative of significant and high correlation between Functional Reach and Biodex System in 20- 40 year old group and between Berg balances Scale and Biodex System in 60-75 years old group [P<0.001]. Also, there was a significant relation between increase in age and decrease in balance capability [P<0.001]. According to our results, the best clinical measuring tool that could replace the expensive aboratory tools of balance assessment is Functional Reach in young people and Berg Balance Scale for old people

Temblor ortostático como causa de inestabilidad postural en enfermedad de Parkinson: Caso clínico / Orthostatic tremor causing postural instability in Parkinson disease: Report of one case

Parkinson disease (PD) is a movement disorder characterized clinically by the variable combination of rigidity, bradykinesia, rest tremor and postural instability. Usually postural instability is a late-onset manifestation and is frequently associated with axial manifestations and with a poor prognosis. We report a 67-year-old female with orthostatic tremor as the etiology of her postural instability. The patient was treated with increasing doses of clonazepam, reaching 2 mg/day, and levodopa. There was an improvement of postural instability with a good response of parkinsonian symptoms.

Equilíbrio dinâmico, estilo de vida e estados emocionais em adultos jovens / Dinamic balance, lifestyle and emotional states in young adults

A one hypothesis to explain some vestibular peripheral disorders is their association with life style. Thus, studies with young adults are relevant. AIM: to analyze the prevalence of dynamic balance alterations in young adults and their possible association with life style variables, health and negative emotional states (since they can impact the outcome). MATERIALS AND METHODS: we carried out a non-probabilistic cross-sectional, clinical-retrospective study with young adults (18-32 years of age) from a university with 751 individuals, with a mean age of 22.45± 3.32 years. Life style, health and negative emotional states (NES) variables - depression, stress and anxiety, were collected by means of an interview. The Unterberger test was used in order to check for indications of dynamic balance alterations. Individuals with altered dynamic balance (ADB) were compared to those without these alterations (controls). RESULTS: From our sample, 642 (83.6 percent) had less than 45º of deviation, while 109 (14.2 percent) had greater than 45º deviation and were the considered with ADB. The ADB group had a greater prevalence of smoking, alcohol abuse/dependence, high blood pressure and NES. CONCLUSION: the study highlights the occurrence of ADB which needs to be corroborated in future studies

Uma hipótese para explicar algumas desordens periféricas vestibulares seria sua correlação com variáveis do estilo de vida. Assim, a realização de estudos populacionais sobre o tema em adultos jovens é relevante. OBJETIVOS: Analisar a prevalência de indicação de alterações no equilíbrio dinâmico em adultos jovens e sua possível associação com variáveis do estilo de vida, saúde e estados emocionais negativos (pois podem intervir nos resultados). MATERIAL E MÉTODO: Foi realizado um estudo epidemiológico transversal, não-probabilístico, retrospectivo-clínico, em adultos jovens (18-32 anos) de uma comunidade universitária com 751 indivíduos, com média de 22.45± 3.32 anos. Variáveis do estilo de vida, saúde e estados emocionais negativos (EEN), que são depressão, ansiedade e estresse, foram coletadas via entrevista. Teste de Unterberger foi aplicado para averiguar indicação de alteração no equilíbrio dinâmico. Indivíduos com equilíbrio dinâmico alterado (EDA) foram então comparados com os sem alteração (controle). RESULTADOS: Da amostra 642 (83.6 por cento) desviaram menos que 45º enquanto que 109 (14.2 por cento) apresentaram um desvio maior que 45º sendo então considerados o grupo EDA. O grupo EDA apresentou maior prevalência de tabagismo, abuso/dependência de álcool, hipertensão arterial sistêmica e de EEN. CONCLUSÃO: O estudo destaca a ocorrência de EDA que precisa ser comprovado em estudos futuros

Avaliação funcional do equilíbrio e da sensibilidade cutânea plantar de idosos moradores na comunidade / Balance and plantar cutaneous sensitivity functional assessment in community-dwelling elderly

Desequilíbrio é um dos muitos fatores de risco que aumenta a susceptibilidade de um idoso a quedas. O equilíbrio pode ser avaliado mediante testes posturais e de sensibilidade plantar. OBJETIVO: Avaliar a ocorrência de desequilíbrio e perda de sensibilidade cutânea plantar em idosos da comunidade e verificar a existência de associação entre ambas as alterações. CASUÍSTICA E MÉTODOS: Estudo transversal descritivo envolvendo 45 idosos submetidos à escala de equilíbrio de Berg (EEB) e ao teste de sensibilidade plantar com monofilamento de nylon. Foram utilizados os testes qui-quadrado e exato de Fisher e elaboradas curvas ROC para estudo da sensibilidade e especificidade da EEB. RESULTADOS: Idosos com alteração do equilíbrio e da sensibilidade cutânea foram em número de 2 e 4, respectivamente. Houve associação significativa entre queixa de desequilíbrio e perda da sensibilidade (p = 0,047) e ocorreu concordância razoável (Kappa: 0,6457) entre a EEB e o teste da sensibilidade. Verificou-se também associação significativa entre 6 dos 14 tarefas da EEB e o teste sensorial. CONCLUSÃO: Idosos vivendo com independência na comunidade, em sua maioria, apresentam equilíbrio e sensibilidade cutânea plantar normais. Quando alteradas estas funções mostram-se associadas de forma que, se os testes forem realizados conjuntamente, a precisão da avaliação do equilíbrio idoso aumenta.

Impaired balance is one of several factors that increase an elderly's susceptibility to falls. Balance assessment can be performed using postural tests and plantar cutaneous sensitivity tests. AIM: To assess balance disorders and loss of plantar cutaneous sensitivity in the elderly and look for association between these alterations. MATERIALS AND METHODS: A descriptive cross-sectional study involving 45 elderly submitted to the Berg Balance Scale (BBS) and the plantar sensitivity test with nylon monofilament. We used chi-square and Fisher's exact tests, and ROC curves were created in order to study the sensitivity and specificity of BBS. RESULTS: Two and 4 individuals showed balance and cutaneous sensation disorders, respectively. There was a significant association between the complaint of impaired balance and loss of skin sensitivity (p = 0.047), and there was a reasonable agreement (Kappa: 0.6457) between the BBS and the sensorial test. A significant association was also found among 6 of the 14 BBS tasks and the sensitivity test. CONCLUSION: Most of the elderly living independently in the community showed normal balance and plantar cutaneous sensation. When impaired, these functions appeared associated in a way that if the tests are performed together, the accuracy of the evaluation of the balance increases.

Non-Motor Off Symptoms in Parkinson's Disease

The aim of this study is to elucidate the clinical spectrum and frequency of non-motor symptoms during off periods (NMOS) in Parkinson's disease (PD) patients with motor fluctuation. We compared clinical characteristics between PD patients with motor symptoms only (M-off) and those with both motor and non-motor symptoms (NM-off) during off periods. The association of NMOS with parkinsonian clinical characteristics was also investigated. Sixty-seven consecutive PD patients of both M-off and NM-off groups were included in this study. We reviewed medical records, interviewed the patients, and administered a structured questionnaire. NMOS is classified into three categories: autonomic, neuropsychiatric and sensory. The frequency of NMOS and their individual manifestations were assessed. Of 67 patients with off symptoms, 20 were M-off group and 47 NM-off group. Among NMOS, diffuse pain was the most common manifestation, followed by anxiety and sweating. There were no significant differences between M-off and NM-off groups with regard to age, duration of disease and treatment, interval between onset of parkinsonian symptoms and off symptoms and off periods. Patients taking higher dosage of levodopa had fewer NMOS. NMOS is frequent in PD. Comprehensive recognition of NMOS can avoid unnecessary tests and is important for optimal treatment in PD.

Estudo da ototoxicidade em trabalhadores expostos a organofosforados / Ototoxicity study in workers exposed to organophosphate

A exposição ocupacional e ambiental aos agrotóxicos evidencia-se como um grave problema de Saúde Pública em nosso país. Entre os sintomas apresentados, a tonteira se destaca, em decorrência de uma provável ação tóxica. OBJETIVO: O objetivo do estudo é caracterizar os resultados do exame vestibular de trabalhadores rurais expostos ocupacionalmente e ambientalmente aos agrotóxicos organofosforados. MATERIAL E MÉTODO: Foi realizado um estudo de coorte com corte transversal em 18 trabalhadores rurais de Teresópolis, RJ. A faixa etária variou de 16 a 59 anos com uma média de 39,6 anos, sendo 5 trabalhadores do sexo masculino e 13 do sexo feminino. Foram utilizados três questionários com perguntas relacionadas à saúde geral e auditiva e perguntas específicas à tonteira e suas relações com o trabalho. Todos os trabalhadores passaram por uma avaliação clínica e realizaram os exames vectoeletronistagmografia e audiometria. RESULTADOS: Os resultados mostraram que 16 trabalhadores apresentaram alterações do equilíbrio corporal de tipo periférico irritativo e 7 trabalhadores apresentaram perdas auditivas do tipo neurossensorial, sugerindo que os agrotóxicos induzem alterações do sistema vestibular através de uma intoxicação lenta e silenciosa. CONCLUSÕES: O olhar clínico sobre esta população exposta a substâncias neuro-ototóxicas requer uma abordagem interdisciplinar, assegurando uma intervenção terapêutica e preventiva eficaz.

Occupational and environmental exposure to agricultural pesticides represent an important health care problem in our country. Among the symptoms presented, dizziness stands out, because of a probable toxic action. AIM: The goal of our study was to characterize vestibular test results from rural workers occupationally and environmentally exposed to organophosphates used in agricultural pesticides. MATERIALS AND METHODS: We carried out a cohort cross-sectional study with 18 rural workers from Teresópolis, RJ. Age ranged between 16 and 59 years, with a mean value of 39.6 years, 5 were males and 13 females. We used three questionnaires with questions associated with general and auditory health, and more specific questions about dizziness and its association with work. All workers underwent clinical evaluation, audiometry and vectoelectronystagmography. RESULTS: results showed that 16 workers had irritative peripheral body balance disorder and 7 workers had sensorineural hearing loss, thus suggesting that agricultural pesticides cause vestibular alterations through a slow and silent intoxication. CONCLUSIONS: medical care for this population exposed to neurotoxic substances require an interdisciplinary approach, to guarantee efficient preventive and therapeutic measures.

Falls in elderly.

Falls are a major health problem among the elderly and an estimated 6% of falls by elderly result in fractures. Early identification of fall risk is likely to result in earlier implementation of intervention and to minimise development of secondary problems such as reduced confidence and activity levels. A comprehensive falls risk factor assessment should be performed for older people who present for medical attention after a fall, those who had more than one fall in the preceding year or those who have abnormalities of gait or balance. Falls are as a result of extrinsic risk factors, intrinsic risk factor or a combination of both. Syncope is defined as a transient, self limited loss of consciousness usually leading to a fall. Syncope and falls are often considered two separate entities with different aetiologies. Disorders affecting balance in the elderly are cerebral, cerebellar, spinal cord disorders; dementia; arrhythmias; postural hypotension; cerebrovascular disease; musculoskeletal/orthopaedic disorders; intervertebral disc disorders; psychological factors; visual impairment. Effective interventions include: (1) Health promotion and falls prevention. (2) Single interventions. (3) Medication review. (4) Exercise. (5) Home modifications. (6) To improve safety in the home. (7) To improve safety outside the home. Effective preventive strategies require better understanding of the causes of and risk factors for falling among elderly.

Clinical Usefulness of the Two-site Semmes-Weinstein Monofilament Test for Detecting Diabetic Peripheral Neuropathy

The present study was done to validate the two-site Semmes-Weinstein (SW) monofilament test in identifying patients at risk of lower-extremity complications in clinical setting. The SW monofilament test and nerve conduction study were conducted on type 2 diabetic patients (n=37) at Pusan National University Hospital in Korea. As the duration of diabetes mellitus was longer, neuropathy identified by nerve conduction study and complications of diabetes were more severe (p<0.01). The number of sites unable to perceive SW monofilament (p<0.001) was larger in patients with lower-extremity neuropathy symptoms than those without symptoms. Sensitivity and specificity at two sites (the third and fifth metatarsal head sites) were 93% and 100%, respectively. In conclusion, the two-site SW monofilament test was a sensitive, specific, simple, and inexpensive screening tool for identifying diabetic peripheral neuropathy in clinical setting.

Neuropatia paraneoplasica con anti-Hu positivo / Paraneoplasic neuropathy with positive anti-Hu

Comunicamos una paciente de 72 años de edad, que presentó inicialmente una neuropatía sensitiva pura y detección de anticuerpos anti-Hu. Comenzó un año previo a su internación con parestesias y disestesias en los 4 miembros. Meses después se agregó inestabilidad para la marcha, y un mes antes de la consulta disminución de fureza en miembros inferiores. El examen neurológico mostró anisocoria con diámetro pupilar derecho de 3 mm y 5 mm para el izquierdo , con fotomotor y consensual abolido bilateralmente; la acomodación se hallaba presente en el ojo derecho. Anestesia en bota y guante, e hipoestesia a todas las formas de sensibilidad en toda la extensión de los 4 miembros. Los reflejos osteotendinosos se hallaban abolidos, y la fuerza estaba levemente disminuida en los músculos flexores y extensores de ambos pies. Se observó movimentos involuntarios (pseudoatetosis) en manos y pies. El estudio neurofisiológico mostró una neuropatía desmielinizante. La determinación de anticuerpos anti-Hu fue positiva (técnica de Western blot - Athena Diagnostics). La tomografía computada (TC) abdominal evidenció metástasis abdominales. La TC de tórax mostró una masa heterogénea en lóbulo inferior derecho y adenomegalia retrocavapretraqueal. La anatomía patológica mostró un carcinoma de células pequeñas. La paciente falleció a los 8 días de externada. El caso corresponde a una polineuropatía sensitiva, eventualmente mixta, que precedió en un año a la detección del tumor pulmonar. En este caso, la clínica fue de curso indolente, con presencia de anticuerpos anti-Hu.

A study of pure neuritic leprosy: clinical experience.

Pure neuritic leprosy is a well-recognized clinical entity. Manifestations of leprosy in pure neuritic form accounted for 179 patients out of the total 3853 leprosy patients (4.6%) attending our Poona Urban Leprosy Investigation Centre clinics. Patients with pure neuritic leprosy are prone to develop nerve damage. Eight-seven (48.6%) of our pure neuritic patients presented with deformities. Involvement of upper extremity and right ulnar nerve in particular was the most common clinical feature. Patients presenting with involvement of two nerves of the same extremity was also quite common. None of our patients developed skin lesions while on anti-leprosy treatment. It is important to recognize neuritic symptoms early and suspect leprosy even in the absence of skin lesions.

Vertigo of cerebrovascular origin proven by CT scan or MRI: pitfalls in clinical differentiation from vertigo of aural origin

To get a better insight into the clinical differentiation between vertigo of cerebrovascular origin and of aural origin, we investigated radiologically proven stroke patients who presented with vertigo as an initial clinical manifestation. Of 154 stroke patients, 30 patients with vertigo (20%) had the relevant lesion, demonstrated with the initial computerized tomographic scan (13 patients) or the follow-up magnetic resonance imaging (MRI) study (17 patients) of the brain. Every lesion was in the vertebrobasilar arterial territory; 19 in the cerebellum, 8 in the pons, and 3 in the medulla oblongata. Although 12 of the 30 patients (40%) presented with vertigo in isolation at the onset of stroke, eight patients (27%) developed additional neurologic abnormalities from four hours to seven days later. Patients with isolated vertigo (13%) had the small lesion exclusively in the cerebellum of the PICA medial branch territory. The most frequent accompanying neurological sign was swaying in the cerebellar and medullary lesion, and dysarthria in the pontine lesion. The direction of nystagmus or swaying did not match the lesion side in some patients. Our findings suggest that cerebellar stroke may commonly manifest isolated vertigo or vertigo with swaying mimicking labyrinthine disorder, particularly at the onset of the disease. MRI study and tests for truncal ataxia and lateropulsion may be crucial for the detection of vertigo of cerebrovascular origin.