Radial keratoneuritis as a presenting sign in Acanthamoeba keratitis

The visual outcomes of Acanthamoeba keratitis, a rare cause of corneal infection, can be devastating. This paper reports two contact lens wearers with severe pain and photophobia who presented to the emergency room. Biomicroscopy revealed radial keratoneuritis in both individuals. Tissue culture on a nonnutrient agar plate with Escherichia coli overlay resulted in a heavy growth of Acanthamoeba. The inpatient treatment included 0.02% polyhexamethylene biguanide, chlorhexidine, neomycin/polymyxin B/bacitracin [Neosporin], and oral fluconazole, which successfully controlled the corneal infection and improvement in the best corrected visual acuity in both patients. Infection did not recur during the 12-month follow-up period. Acanthamoeba keratitis can present as radial keratoneuritis, mimicking other common corneal infections resulting in diagnostic and treatment delays. Early diagnosis and prudent treatment of Acanthamoeba keratitis are the keys to restoring vision and avoiding the subsequent need for penetrating keratoplasty

Neuropatía hanseniana en una adulta joven / Hansenian neuropathy in a young adult

Se presenta el caso de una paciente de 27 años de edad, sin previos antecedentes, que en el período de puerperio comenzó a presentar deterioro neurológico progresivo, dificultad para la marcha, graves trastornos sensitivos, del tipo de las parestesias y artralgias, pérdida de la sensibilidad propioceptiva, al tacto, al dolor, a la temperatura y en zonas dístales de miembros inferiores, además de manchas violáceas en tórax, abdomen y rodillas. En la muestra para biopsia se encontró un patrón inflamatorio compatible con lepra lepromatosa.

The case of a 27 year-old patient without previous history is reported, who in the puerperium began to present with progressive neurological deterioration, difficult walking, serious sensitive conditions such as paresthesia and arthralgia, loss of the proprioceptive sensibility to the tact, pain, temperature and in distal areas of inferior extremities besides violaceuos plaques in thorax, abdomen and knees. In the biopsy sample an inflammatory pattern consistent with lepromatous leprosy was found.

An immunohistochemical, clinical and electroneuromyographic correlative study of the neural markers in the neuritic form of leprosy

The nerve biopsies of 11 patients with pure neuritic leprosy were submitted to routine diagnostic procedures and immunoperoxidase staining with antibodies against axonal (neurofilament, nerve growth factor receptor (NGFr), and protein gene product (PGP) 9.5) and Schwann cell (myelin basic protein, S-100 protein, and NGFr) markers. Two pairs of non-adjacent histological cross-sections of the peripheral nerve were removed for quantification. All the fascicles of the nerve were examined with a 10X-ocular and 40X-objective lens. The immunohistochemistry results were compared to the results of semithin section analysis and clinical and electroneuromyographic data. Neurofilament staining was reduced in 100 percent of the neuritic biopsies. NGFr positivity was also reduced in 81.8 percent, PGP staining in 100 percent of the affected nerves, S100 positivity in 90.9 percent, and myelin basic protein immunoreactivity in 90.9 percent. Hypoesthesia was associated with decreased NGFr (81.8 percent) and PGP staining (90.9 percent). Reduced potential amplitudes (electroneuromyographic data) were found to be associated with reduced PGP 9.5 (63.6 percent) and nerve fiber neurofilament staining (45.4 percent) by immunohistochemistry and with loss of myelinated fibers (100 percent) by semithin section analysis. On the other hand, the small fibers (immunoreactive dots) seen amid inflammatory cells continued to be present even after 40 percent of the larger myelinated fibers had disappeared. The present study shows an in-depth view of the destructive effects of leprosy upon the expression of neural markers and the integrity of nerve fiber. The association of these structural changes with the clinical and electroneuromyographic manifestations of leprosy peripheral neuropathy was also discussed.

The diagnosis of leprosy among patients with symptoms of peripheral neuropathy without cutaneous lesions: a follow-up study

Forty-four patients with neuritic leprosy were individually followed for periods ranging from 4 months to almost 4 years for the purpose of ascertaining the presence and/ or absence of leprosy. The neural symptoms presented were sensory impairment (41), parasthesia (28), nerve enlargement (22), nerve tenderness (20), paresia (20), amyotrophy (8). Leprosy was diagnosed in ten out of the total number of patients studied. Leprosy was confirmed by the appearance of reactional neuritis (4), reversal reaction (2), biopsy of the hypoesthesic area (3) and the appearance of non-reactional cutaneous lesion. We reported an experience in the diagnosis of neuritic leprosy and its most frequent clinical presentation with which clinicians have to be acquainted. We can also state that the clinical follow-up was an effective strategy for the diagnosis of the disease when diagnostic facilities are not available or have not confirmed the diagnosis

RM en neurosífilis: presentación atípica como neuritis trigeminal, comunicación de un caso / MR in neurosyphilis: trigeminal neuritis

Presentamos los hallazgos por RM de un caso de neuritis trigeminal bilateral como manifestación atípica de neurosífilis en un paciente varón, de 34 años, HIV + para demostrar la utilidad de la RM como método para la valoración postratamiento, arribando a las siguientes conclusiones: 1) la neuritis trigeminal constituye una presentación excepcional de la neurosífilis. No hemos encontrado reportes al respecto en la literatura imagenológica; 2) la RM con cortes de alta resolución y con gadolinio no sólo demuestran con claridad los cambios inflamatorios en los trigéminos sino que, además, podría detectar lesiones silentes o subclínicas (nuestro paciente mostraba realce bilateral y tenía manifestaciones clínicas sólo del lado derecho) y 3) la RM sin y con gadolinio es un método adecuado para valorar la respuesta al tratamiento en casos de neuritis trigeminal

Mononeuropatía múltiple y vasculitis / Multiple mononeuropathy and vasculitis

Background: Seventy percent of vasculitis are neurologically expressed as multiple mononeuropathy (MM) or asymmetrical neuropathy (AN). Concurrent nerve and muscle biopsy increases the diagnostic accuracy of the disease. Aim: To define the pathological features of vascular damage in nerve and muscle in patients with MM or AN. Patients and methods: Between 1980 and 1997, 50 patients with a MM or AN diagnosis, based on neurological and neurophysiological findings, were studied at the Neurology Department of Hospital del Salvador. All underwent nerve and muscle biopsy (of the superficial peroneal nerve and the short peroneal muscle). Slices were stained with hematoxylin eosin, luxol fast blue and Gomori staining. Results: Forty two patients, aged 52 ñ 15 years old (29 female) had a vasculitis. These subjects with MM or AN associated to vasculitis, corresponded to 22 percent of neuropathies subjected to nerve biopsy at the Department in the study period. Thirty two cases (76 percent) had necrotizing arteritis, characterized by wall fibrinoid necrosis and lumen occlusion in large vessels (>100 microns), with Iymphoplasmocytic and macrophage infiltration. Ten cases showed an inflammatory reaction and endothelial proliferation without wall necrosis, specially in small epineural arteries. Vascular recanalization was found in 33 percent of cases. Diagnostic vascular changes were found in 87 percent of nerve biopsies and 53 percent of muscle biopsies. No definitive relationship between the intensity of vascular and nerve lesions was found. All muscle biopsies showed some degree of neurogenic atrophy and 5 had micro infarcts. Conclusions: Superficial peroneal nerve biopsy is diagnostic in most patients with MM or AN associated with vasculitis. Nerve and muscle biopsies are complementary in the diagnostic work up

Características clínico-histopatológicas dos estados reacionais na hanseníase em pacientes submetidos à poliquimioterapia (PQT) / Clinical and histopathological characteristics of reactional states in leprosy patients submitted to multi-drug therapy

O objetivo deste estudo foi analisar os aspectos clínicos e histopatológicos dos estados reacionais em 169 pacientes multibacilares submetidos à poliquimioterapia. Em adiçäo foram avaliadas a frequência e a distribuiçäo desses episódios reacionais. Os casos foram classificados, com base nos dados clínicos e histopatológicos, em eritema nodoso hansênico - ENH (51 porcento), reaçäo reversa - RR (42 porcento) e neurite isolada (7 porcento). Verificou-se que os episódios reacionais säo complicaçäo freqüente (59 porcento) e ocorrem em qualquer momento no curso da doença. Observou-se que 77 porcento dos pacientes que desenvolveram ENH e 43 porcento dos pacientes com RR apresentaram manifestaçöes sistêmicas. A RR predominou entre os pacientes portadores da forma borderline-borderline (74 porcento), enquanto o ENH predominou naqueles diagnosticados pela forma lepromatosa-lepromatosa (86 porcento). O ENH foi significativamente mais recorrente do que a RR, que predominou no primeiro ano de PQT, enquanto o ENH no segundo ano

Fasceítis eosinofílica con polineuropatía autoinmune y mucinosis papulosa / Eosinophylic fasceitis with autoimmune polyneuropathy and papular mucinosis

La fasceítis eosinofílica es un cuadro clínico de curso benigno que aparece en general tras un esfuerzo físico importante. Se presenta un paciente de 60 años, sexo masculino, con una fasceítis eosinofílica de extenso compromiso cutáneo, polineuropatía y mucinosis papulosa, con buena respuesta al tratamiento combinado con corticoides y cimetidina

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.

Mononeurite múltipla / Multiplex Mononeuritis

Apresenta-se caso de paciente com mononeurite múltipla subaguda, no contexto de doença vasculítica sistêmica (poliarterite nodosa). O diagnóstico seguro foi obtido a partir de biópsia de pele, músculo esquelético e nervo periférico. Revisa-se a literatura, salientando-se aspectos etiopatogênicos, fisiopatológicos e, especialmente, conduta terapêutica

Parálisis cordal y alcoholismo / Vocal cord paralysis and alcoholism

La parálisis recurrencial por alcoholismo es un hallazgo muy raro, si bien la literatura mundial menciona algunos casos. La inercia de las cuerdas vocales es debido a una neuropatía por probable déficit de vitamina B1 (tiamina). El siguiente trabajo relata una interesante manifestación clínica en un paciente alcohólico quien presentó disfonía, diagnosticándose paresia recurrencial izquierda cuya etiología, luego de descartar las causas más frecuentes y considerando que evolucionó favorablemente con vitamina B1, resultó ser una neuritis recurrencial alcohólica.

Estudio de cinco grupos de pacientes con neuropatía epidémica: Hospital General "Santiago" / Study of five groups of patient with epidemic neuropathies General: Hospital \"Santiago\"

Se realizó un estudio prospectivo y longitudinal con el objetivo de mostrar la evaluación de 5 grupos de estudio en pacientes con neuropatía epidémica, escogido 135 pacientes del Hospital General "Santiago", período de mayo a julio de 1993.El riesgo asociado que predominó fue el déficit de complejo B y el hábito de fumar, presentaron síntomas de malestar general, el sexo más afectado resultó ser el femenino, el grupo etareo entre 31 y 45 años el de mayor incidencia.Uno de los grupos que recibió tratamiento con vitaminoterapia sólo presentó 2 síntomas diferentes, por lo que hubo una evolución favorable

Post-infective polyneuritis-a record study from 1982-89

The purpose of this study was to assess the incidence of post-infective polyneuritis in Pakistan, particularly in Multan region. A total of 51 patients were included, 66% were male and 34% female diagnosed during the period of June 1982 to October 1989. The overall mortality was 35.5%. The mortality has shown a definite decrease over the years because of improved arrangements. A few cases diagnosed as post-infective polyneuritis, on admission were found to be the result of Electrolyte imbalance. A few children were also sent to the ICU unit, and were found to be suffering from poliomyelitis

Doença de Ménière - Parte III / Ménière's disease - Parte III

Os autores fazem estudo do estado atual de conhecimentos sobre a doença de Ménière. Tecem considerações sobre o exame do aparelho vestibular, o que quer dizer, o estudo dos sistemas vestíbulo-espinhal e vestíbulo-oculomotor. Fazem referência a doença de Ménière não idiopática e apreciação sobre as causas, exames subsidiários e diagnóstico diferencial. Foram estudados 83 casos