Sarcoidose como diagnóstico diferencial de mieloma múltiplo / Sarcoidosis as a differential diagnosis of multiple myeloma

A sarcoidose caracteriza-se como doença granulomatosa que acomete diferentes órgãos humanos, especialmente os pulmões, sendo sua patogênese pouco conhecida. No caso em questão, a paciente iniciou com sintomas inespecíficos, como fraqueza, perda ponderal e tosse seca esporádica, sendo internada para extensão da propedêutica. Sugeriu-se como hipótese diagnóstica inicial possível quadro de mieloma múltiplo, tendo em vista a anemia, a disfunção renal, a hipercalcemia e, sobretudo, as lesões osteolíticas apresentadas pela paciente. Todavia, o diagnóstico de sarcoidose foi selado a partir das biópsias de medula óssea e de linfonodo inguinal, que evidenciaram mielite e linfadenite granulomatosas, respectivamente. A terapêutica instituída baseou-se na administração de corticosteroides e em medidas de redução da calcemia. A paciente recebeu alta, com melhora do quadro clínico, para acompanhamento ambulatorial da doença. Conclui-se que a sarcoidose não possui tratamento curativo, mas a terapêutica imunossupressora é eficaz no controle da progressão da enfermidade, fazendo com que o paciente tenha um prognóstico favorável.

Sarcoidosis is characterized as a granulomatous disease that affects different human organs, especially the lungs, and its pathogenesis is little known. In this case, the patient started with nonspecific symptoms, such as weakness, weight loss, and sporadic dry cough, being hospitalized for extension of the propaedeutics. The initial diagnostic hypothesis suggested was a possible case of multiple myeloma, based on the anemia, renal dysfunction, hypercalcemia and, above all, the osteolytic lesions presented by the patient. However, the diagnosis of sarcoidosis was made after bone marrow and inguinal lymph node biopsies that showed granulomatous myelitis and lymphadenitis, respectively. The therapy instituted was based on the administration of corticosteroids and on measures to reduce the level of calcium. The patient was discharged, with clinical improvement, for outpatient follow-up of the disease. It is concluded that sarcoidosis has no curative treatment, but immunosuppressive therapy is effective in controlling the progression of the disease, giving the patient a favorable prognosis.

Aumento inusual de casos de mielitis en un hospital pediátrico en Argentina / Unusual increase of cases of myelitis in a pediatric hospital in Argentina

Introducción: La asociación entre enterovirus D68 y cuadros de mielitis aguda fláccida ha sido descrita en Estados Unidos, en 2014. Desde ese año, se han reportado casos esporádicamente en Canadá y Europa. Se describe, en este estudio, una serie de casos con mielitis aguda fláccida en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" en Buenos Aires, Argentina, en 2016. Métodos: Estudio descriptivo, retrospectivo. Se incluyeron todos los pacientes internados desde el 1/04/2016 al 1/07/2016 con mielitis fláccida aguda con lesiones en la médula espinal que comprometieran la sustancia gris en la resonancia magnética nuclear. Se procesaron, para la búsqueda etiológica, muestras de secreciones nasofaríngeas, hisopados de materia fecal y líquido cefalorraquídeo. Resultados: Se incluyeron 10 pacientes. La mediana de edad fue 4 años (rango de 3 meses a 5 años). Ocho pacientes tuvieron una enfermedad febril autolimitada antes del inicio de los síntomas neurológicos. Los hallazgos neurológicos fueron debilidad fláccida de, al menos, un miembro, cervicoplejia (n= 2) y parálisis facial (n= 2). Todos los pacientes presentaron lesiones longitudinales en la médula espinal, con compromiso de sustancia gris, predominantemente, en el asta anterior. En todos los casos, se realizó una punción lumbar. En 7 pacientes, se observó pleocitosis. En cuatro niños, se identificó enterovirus D68 en secreciones nasofaríngeas y, en uno, se identificó el enterovirusD68 en el líquido cefalorraquídeo. Todos los pacientes persistieron con déficits neurológicos al momento del alta. Conclusiones: Se reporta el primer brote de mielitis aguda fláccida asociada a enterovirusD68 en Argentina. La vigilancia epidemiológica activa permitirá conocer la verdadera incidencia, epidemiología y etiología de esta enfermedad.

Introduction: The association between enterovirus D68 and acute flaccid myelitis was first described in the United States in 2014. Since then, sporadic cases have been reported in Canada and Europe. This study describes a series of cases of acute flaccid myelitis at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," in Buenos Aires, Argentina, during 2016. Methods: Descriptive, retrospective study. All patients with acute flaccid myelitis and lesions in the spinal cord involving the gray matter, as observed in the magnetic resonance imaging (MRI) scan, hospitalized from 04/01/2016 to 07/01/2016, were included in the study. Samples of nasopharyngeal secretions, fecal swabs and cerebrospinal fluid were collected and processed to look for the causative agent. Results: Ten patients were included. The median age was 4 years old (range from 3 months to 5 years old). Eight patients had a self-limiting febrile condition before the onset of neurological symptoms. Neurological findings were flaccid weakness in, at least, one limb, cervical paralysis (n= 2) and facial paralysis (n= 2). All patients had longitudinal lesions in the spinal cord, with gray matter involvement, mainly in the anterior horn. In all cases, a lumbar puncture (spinal tap) was performed. Pleocytosis was observed in 7 patients. In four children, enterovirus D68 was identified in nasopharyngeal secretions, and in one, it was detected in the cerebrospinal fluid. Neurological deficit persisted in all patients at the time of discharge. Conclusions: The first outbreak of acute flaccid myelitis associated to enterovirus D68 is reported in Argentina. Active epidemiological surveillance will help to determine the true incidence, epidemiology and etiology of this disease.

Infecciones por el virus EV-D68 en niños hospitalizados en un hospital de alta complejidad / EV-D68 virus infections in children admitted to a tertiary-care hospital

Introducción: Los reportes de infecciones por enterovirus D68 (EV-D68) han aumentado en los últimos años. Material y métodos: Cohorte prospectiva. Se realizó la búsqueda de EV-D68 en niños internados en el Hospital de Pediatría Juan P. Garrahan entre 1-5-2016 y 30-9-2016 con: infección respiratoria aguda baja (IRAB) que requirieran cuidados intensivos, parálisis aguda fláccida (PAF) asimétrica con compromiso de sustancia gris en resonancia magnética nuclear (RMN) o identificación de cualquier enterovirus con cuadro clínico compatible. La identificación de EV-D68 se realizó en el Servicio de Neurovirus, Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. CG. Malbrán". Resultados: n: 6. PAF: cuatro niños presentaron PAF asimétrica, con arreflexia y RMN compatible con mielitis. Requirieron ventilación mecánica en unidades de cuidados intensivos (UCI) dos de los 4 niños. Todos presentaron parálisis residual. Se identificó EV-D68 en secreciones nasofaríngeas (SNF) de todos ellos. En líquido cefalorraquídeo sólo en uno. Miocarditis: Una niña sana de 5 años se internó en UCI por disfunción miocárdica y fiebre. Presentaba además derrame pericárdico moderado. Recibió gamaglobulina e.v. con buena evolución. En SNF se identificaron virus sincicial respiratorio (VSR) y EV-D68. IRAB grave: se identificó EV-D68 en un paciente de 14 meses que permaneció en UCI por IRAB grave con requerimientos de ventilación no invasiva por 72 hs, con buena evolución posterior. Se constató coinfección VSR y EV-D68 en SNF. Conclusiones: Se reportan 6 pacientes internados con infección por EV-D68. La vigilancia epidemiológica activa es esencial para identificar la circulación, las características clínicas y el pronostico de las infecciones por virus emergentes (AU)

Introduction: Reports on enterovirus D68 (EV-D68) infections have increased over the past years. Material and methods: A prospective cohort study. A search for EV-D68 infection was conducted in children hospitalized at Hospital de Pediatría Juan P. Garrahan between 1-5-2016 and 30-9-2016 with: acute lower respiratory infection (ALRI) requiring intensive care unit (UCI) admission, acute flaccid paralysis (AFP), asymmetry with grey matter involvement on magnetic resonance imaging (MRI), or identification of any enterovirus associated with compatible features. The identification of EV-D68 was performed at the Department of Neuroviruses of the InstitutoNacional de EnfermedadesInfecciosas INEI-ANLIS "Dr. CG. Malbrán". Results: n: 6. AFP: four children had asymmetric AFP with areflexia and MRI compatible with myelitis. Two of four required mechanical ventilation in the ICU. All of them presented with residual paralysis. EV-D68 was identified in the nasopharyngeal swab (NPS) in all of them and in the cerebrospinal fluid in only one. Myocarditis: A 5-year-old healthy girl was admitted to the ICU because of myocardial dysfunction and fever associated with moderate pericardial effusion. She was put on IV gamma globulin with a good response. In the NPS respiratory syncytial virus (RSV) and EV-D68 were identified. Severe ALRI: EV-D68 was identified in a 14-month-old patient who was admitted to the UCU because of severe ALRI requiring non-invasive ventilation for 72 hours with a good outcome. A RSV and EV-D68 coinfection was found in the NPS. Conclusions: We report six inpatients with a EV-D68 infection. Active epidemiological surveillance is crucial to identify circulation of the virus, clinical features, and prognosis of emerging viruses (AU)

Reporte de 2 casos de mielopatía progresiva tardía posradiación / Report of two cases of late progressive myelopathy postradiation

Las complicaciones de la radioterapia se pueden presentar de manera aguda, subaguda o retardada y son diferentes en sus manifestaciones, según afecten al cerebro, la médula espinal o los nervios periféricos. Se presentaron 2 pacientes que recibieron tratamiento con radioterapia y después de un año del proceder terapéutico desarrollaron manifestaciones clínicas e imaginológicas compatibles con una mielopatía posradiación. Ninguno ha tenido progresión de la enfermedad con el uso de los esteroides aplicados...

Complications of radiation therapy can occur in acute, subacute or delayed manner and they are different in manifestations, as they affect the brain, spinal cord or peripheral nerves. Two patients who were treated with radiotherapy were presented and after a year of therapeutic procedure, they developed clinical manifestations and imaging features consistent with a post-radiation myelopathy. None had disease progression with the use of steroids...

Encefalitis del tallo cerebral y mielitis por Listeria monocytogenes / Brainstem encephalitis and myelitis due to Listeria monocytogenes : a case report and literature review

La romboencefalitis por Listeria monocytogenes es una presentación poco común de la listeriosis del sistema nervioso central; sin embargo, es la presentación más común en personas inmunocompetentes. Aun más rara es la combinación de romboencefalitis con mielitis causada por L. monocytogenes ; no obstante, en este artículo se reporta un caso de encefalitis del tallo y mielitis grave en un paciente sin compromiso del sistema inmunitario. Se presenta un paciente de 21 años de edad, sin deficiencias del sistema inmunitario, que consumió productos lácteos no pasteurizados y, posteriormente, presentó un cuadro de cefalea, vómito, deterioro de su estado general y, finalmente, alteración del estado de conciencia y muerte. Consultó al Instituto Neurológico de Colombia y se hizo diagnóstico de encefalitis del tallo y mielitis por L. monocytogenes . Se discuten las diferencias entre el caso presentado y los reportados en la literatura científica. Ante un paciente con signos de compromiso del tallo cerebral, de posible origen infeccioso, es prudente iniciar tratamiento antibiótico para L. monocytogenes y, en caso de poca respuesta, escalar rápidamente en dicho tratamiento. También lo es extender el estudio radiológico hacia la columna vertebral, con el fin de descartar compromiso de la médula espinal.

Brainstem encephalitis caused by Listeria monocytogenes is an uncommon form of central nervous system listeriosis; however, it is the most common presentation in immunocompetent individuals. Here, we describe an even more rare combination of rhombencephalitis with severe myelitis caused by L. monocytogenes in an immunocompetent patient. We report the case of a 21-year-old immunocompetent patient who consumed unpasteurized dairy products and experienced headache and vomiting that progressed to an impaired general condition, altered consciousness and ultimately death. The patient had presented to the Neurological Institute of Colombia (INDEC in Spanish) for consultation and was diagnosed with brainstem encephalitis and myelitis caused by Listeria monocytogenes . The differences between this particular case and those reported in the literature will be discussed. It is advisable to initiate antibiotic treatment for Listeria monocytogenes if a patient shows signs of brainstem compromise of possible infectious origin and quickly intensify treatment if there is no or minimal response. It is also necessary to extend radiological assessment to include the spinal column to rule out spinal cord involvement.

Mielites infecciosas / Infeccious myelitis

As mielopatologias possuem etiologias variadas, incluindo: trauma, autoimunidade, neoplasia, vascular, hereditária, degenerativa, e infecciosa. Este artigo descreve as causas infecciosas mais comuns de disfunção da medula espinhal.

The pathologies of the spinal cord have different etiologies. Besides trauma, other common causes of myelopathy include also autoimmune, neoplastic, vascular, hereditary, degenerative and infectious diseases. Therefore, this article will review some of the most common infectious causes of dysfunction of the spinal cord and their pathogenesis, clinical manifestations and diagnosis correlate. Method: Scientific papers published in national and international medical journals available on CAPES, Pubmed and Uptodate, were reviewed.

Mielorradiculopatia esquistossomótica: relato de caso / Schistosomal myeloradiculopathy: case report

A mielite é a forma neurológica mais grave da esquistossomose mansoni. Este relato descreve paciente com dor lombar, seguida de paraparesia e parestesia em membros inferiores, associadas com alterações urinárias. Havia eosinofilia (16 por cento), e eosinofilorraquia (39 por cento), além de contato com águas naturais de região endêmica para o S. mansoni. O paciente foi prontamente tratado com praziquantel e corticoesteróides, evoluindo com regressão das queixas e ausência de sequelas. Enfatiza-se a necessidade de se considerar a mielite no diagnóstico diferencial de dor lombar, com paresia e parestesias, além de alterações urinárias, visto que o inicio precoce do tratamento determina o prognóstico.

Schistosomal myelitis is the severest neurologic complication of schistosomiasis mansoni. We report a case in which the patient developed lumbar pain followed by paraparesis and paresthesia in lower limbs with urinary retention. There was eosinophilia (16 percent) and eosinophilorraquia (39 percent) and a history of contact with natural waters in an endemic area. The patient was treated with praziquantel and steroids; he presented rapid response to treatment with regression of symptoms and developed no sequelae. The authors emphasize the need to consider this condition in the differential diagnoses of low back pain, paraparesis/paresis and urinary retention, since early treatment is crucial to a good prognosis.

Spinal gnathostomiasis resembling an intrinsic cord tumor/myelitis in a 4-year-old boy.

A 4-year-old boy presented with fever, myalgia followed by progressive quadriparesis and urinary retention. Spinal fluid from a lumbar puncture showed 42 WBC/microl with 100% lymphocytes, no RBC, a glucose of 54 mg/dl (blood glucose 107 mg/dl), and a protein of 39 mg/dl. The cerebrospinal fluid culture was negative. His white blood cell count was 10,860 cells/microl with a normal differential count. An MRI of the brain was negative. An MRI of the whole spine showed fusiform dilatation of the cervical cord from the cervicomedullary junction to the T4 level. The tentative diagnosis was acute hemorrhage of an intrinsic cord tumor versus acute myelitis. Intravenous dexamethasone was administered which resulted in a slight improvement in strength. One week later, he deteriorated precipitously and became flaccidly quadriplegic. Since the patient deteriorated rapidly and no definitive diagnosis was made, the patient underwent cervical cord biopsy. Intraoperatively, after the cervical cord had been opened, a living Gnathostoma spinigerum was found in the spinal cord parenchyma. The nematode was removed. Following the operation the patient was placed on albendazole 400 mg/d and metronidazole 250 mg three times per day for 3 weeks. He gradually improved over the next several weeks.

Abordagem inicial do paciente com mielopatia aguda não compressiva / Acute non compressive myelopathy

As mielopatias agudas são caracterizadas por sinais e sintomas sensitivos, motores e autonômicos secundários à disfunção medular. Por serem relativamente raras, muitas vezes há dificuldade em realizar-se o diagnóstico, com atraso na instituição do tratamento. Devido a isso, revisamos a literatura com intuito de descrever as características das principais causas de mielopatias agudas não compressivas: 1) doenças desmielinizantes; 2) secundária a doenças sistêmicas; 3) parainfecciosa; 4) pós-radiação tardia; 5) secundária a alterações vasculares; 6) idiopática; e 7) por deficiência de vitamina B12. Após, sugerimos um algoritmo para auxílio na abordagem inicial e na investigação etiológica destes pacientes.

Investigação sobre a ocorrência de esquistossomose mansônica medular autóctone em uma região com baixa endemicidade(Campinas-SP) / Study on the occurrence of Schistosomiasis Mansoni in a low endemic area (Campinas, SP)

Os programas de controle da esquistossomose têm obtido relativo sucesso ao controlar a morbidade relacionada a altas cargas parasitárias desta doença, sem, no entanto, diminuir a área de transmissão no Brasil. Como a neuroesquistossomose medular á uma forma grave de esquistossomose não relacionada a altas cargas parasitárias existe risco teórico de ocorrer em áreas de baixa endemicidade. O objetivo deste estudo foi estudar a ocorrência da NE (neuroesquistossomose) medular em uma região de baixa endemicidade, região de Campinas, estado de São Paulo. Foi feito um estudo retrospectivo, descritivo de base hospitalar com busca ativa em múltiplas fontes de informação. Utilizou-se como base os dois maiores hospitais públicos da região de Campinas. Os pacientes com diagnóstico de NE medular tiveram seus diagnósticos ratificados por critérios padronizados e baseados em quadro clínico típico, comprovação da infecção por Schistosoma mansoni e exclusão de outras causas de mielopatia. Os pacientes foram classificados como autóctones, importados, sem informação e indeterminado. Após esta classificação os dados clínicos e epidemiológicos foram analisados. Foram identificados 27 pacientes com NE medular dos quais 19 (85,2%) homens e 4 (14,8%) mulheres, as idades no momento do diagnóstico foram de 13 a 57 anos (média=31,2; desvio padrão= 12,8 e mediana=29). Os pacientes foram classificados quanto ao local provável de infecção da seguinte forma: 14(51,9%) autóctones, 11(40,7%) importados e 2(7,4%) sem informações, não houve paciente classificado como indeterminado. Todos os pacientes importados se infectaram em municípios de áreas de alta endemicidade. A clínica deste grupo de pacientes não foi diferente do encontrado na literatura, nem foi diferente quando comparados os pacientes autóctones com os importados. Houve uma demora média de 70,6 dias (mediana=19; dp=166,9) entre a primeira consulta e o diagnóstico...

Programs for schistosomiasis control have enjoyed relative success in controlling death associated to high parasitary loads for this illness, without, however, decreasing the area of transmission in Brazil. Since spinal neuroschistosomiasis is a grave form of neuroschistosomiasis unrelated to high parasitary loads, there is a theoretical risk of its occurrence even when not in a particularly endemic area. The goal of this study was to study the occurrence of spinal NE (neuroschistosomiasis) in a non-endemic area, the region of Campinas, in the Sate of São Paulo. A retrospective, descriptive, hospital-based study was carried, with information actively sought after from various sources of information. The two largest public hospitals in the region of Campinas were used as bases. The patients diagnosed with spinal NE had their diagnoses ratified according to standard criteria and based on typical clinical status, proof of infection by Schistosoma mansoni and the exclusion of other causes for myelopathy. Patients were classified as autochthonous, imported, without information and undetermined. After this classification, the clinical and epidemiological data were analyzed. A total of 27 patients with spinal NE were identified, of which 19 (85.2%) were men and 4 (14.8%) women. The ages on diagnosis ranged from 13 to 57 (average=31.2; standard deviation=12.8 and median=29). The patients were classified as to their probable location of infection the following way: 14(51.9%) autochthonous, 11(40.7%) imported and 2(7.4%) without information. No patients were deemed undetermined. All imported patients were infected in municipalities located in highly endemic areas. Clinical evaluation of this group of patients was no different from that found in the literature, nor was it different when autochthonous patients were compared to imported patients. There was an average period of 70.6 days (median=19; sd=166.9) between the first consultation and diagnosis.

Meningoencefalite e polioencefalomalacia causadas por Herpesvírus bovino-5 no estado do Pará / Meningoencephalitis and polioencephalomalacia caused by bovine herpesvirus-5 in the state of Pará, northern Brazil

O presente trabalho relata quatro casos de meningoencefalite por BHV-5 em quatro municípios no estado do Pará afetando bovinos de 1-2 anos, criados extensivamente. Três casos ocorreram de forma isolada e em um caso foram atingidos 3 animais do rebanho. Os principais sinais clínicos observados foram incoordenação, depressão acentuada, cegueira, decúbito lateral, opistótono e morte. O curso clínico foi de 3-4 dias. Macroscopicamente observaram-se áreas amolecidas, amareladas e cavitações no córtex cerebral. Microscopicamente observaram-se poliencefalomalacia no córtex cerebral, tálamo e núcleos da base, encefalite e meningite não supurativa e corpúsculos de inclusão intranucleares eosinofílicos em astrócitos. O diagnóstico foi realizado com base nos achados histológicos característicos.

correlative role of contrast-enhanced MR in evaluation of myelopathic changes in patients with progressive and clinically-active multiple sclerosis

During a period of time extending from January 2003 to May 2004, 16 patients [12 females and 4 Males] of ages ranging from 17-40 years and suffering from multiple sclerosis of the CNS with superadded myelopathic changes were involved in this study. All patients were initially evaluated on neurologic basis to asses the extent of disability according to a variety of functional assessment scores [EDSS and ambulation test of Kertzke] that was followed by an initial pre/ post contrast MR examination of the brain and cervical/dorsal spinal cord using a 1.5 T MR Units where analysis of the obtained images to get a basis datae as regard the morphologic criteria of any detected focal lesions including their site, shape, sizes in mm [to get the total lesion load of the brain and cord at this basis sitting], counts and postcontrast pattern of enhancement, follow-up clinical and MR exarninations were performed for all patients twice [at 3 and 6 months interval] so that a total of 32 follow-up examinations were done in addition to the initial ones to estimate the changes involving the initially detected lesions [according to the same morphologic basis], to detect any newly developing lesions and to asses the diagnostic value of contrast injection in monitoring of the clinically active lesions. In our study a moderate correlation between lesion load and sensory function and EDSS was noted. A majority [70%] of patients with new clinical manifestations had one or two enhancing lesions. Agreement of MR-findings and clinical examination was noted in almost 60% of the follow up examinations MR showed lesion progression in 44% of patients with clinical deterioration and 35% of those with clinical improvement or stability. We have finally concluded that MR imaging is the most accurate diagnostic procedure in monitoring multiple sclerosis lesions of the brain and/or spinal cord even in submanifest stage and in providing an undoubted evidence of lesions activity on both initial and serial scans. So, the procedure is an essential one that should be done documentarily and complementarily hand by hand with clinical assessments

Recurrent herpes zoster myelitis

Recurrent zoster myelitis is quite rare. We present a previously healthy 27-year-old woman who developed recurrent attacks of myelopathy shortly after the characteristic skin rashes of herpes zoster. Magnetic resonance imaging studies demonstrated each lesion in the spinal cord at the same segments as the skin lesions. She had two attacks at opposite sites at the same spinal cord level and complete recovery after being treated with intravenous acyclovir. We suspect that direct invasion of varicella zoster virus was the cause of recurrent myelopathy in our patient.

Study of myelitis: epidemiology, clinical aspects and laboratory studies

Twenty patients with acute transverse myelitis appearing as the first neurological episode [13 males and 7 females] fulfilling the criteria of Berman and other 10 apparently healthy controls were selected for this study and subjected to detailed history taking, full neurological examination, plain X-ray, myelography and spinal CT examination, CSF examination for cells, protein, glucose and microbiological tests for any growth and estimation of some serum and CSF immunoglobulins using immunodiffusion plate technique. The results were given

Mielopatia por esquistossomose mansônica em crianças / Myelopathy due to schistosomiasis mansoni in children

Trata-se de relato clínico de seis crianças (quatro meninos e duas meninas) que apresentaram uma mielorradiculopatia aguda devido a infecção pelo S. mansoni. As idades variaram entre 21 meses e 10 anos. Três apresentaram a forma hepatoesplênica e três a forma intestinal da esquistossomose. Ovos de S. mansoni estavam presentes nas fezes de cinco casos. Testes imunológicos foram realizados no LCR em cinco casos com resultados positivos em apenas dois. Eosinorraquia (1 a 25 por cento) estava presente em cinco casos. Os níveis de proteínas variaram de 63 a 350 mg por cento. Gama-globulinas foram dosadas em três casos estando elevadas em dois. Todas as crianças não podiam andar uma semana após o início dos sintomas. Sinais radiculares estavam presentes em quatro casos. Distúrbios de sensibilidade e dos enfíncteres estavam presentes em três casos. Todos os pacientes foram tratados com oxaminiquine e cinco receberam corticosteróides. Em cinco casos os sintomas neurológicos regrediram completamente entre 20 dias e 10 meses. Em um caso a paraplegia permaneceu inalterada 45 dias após o início da doença. O diagnóstico de esquistossomose espinal baseia-se em dados clínicos, epidemiológicos e laboratoriais, bem como na resposta ao tratamento. Testes imunológicos têm boa especificidade mas pouca sensibilidade

Algunas complicaciones neurológicas de la brucelosis / Some neurological complications of the brucellosis

Se presenta tres casos de Brucelosis con alteraciones neurológicas, caracterizadas por meningoencefalitis, meningomielitis y poliradiculoneuritis. El diagnóstico se comprobó por títulos altos para Brucella en el suero para los tres casos y hemocultivo positivo en los dos primeros. Todos los pacientes presentaron LCR de carácter inflamatorio y evolución favorable cuando el tratamiento antibiótico fue el adecuado. En los tres casos el diagnóstico inicial fue rectificado posteriormente por las pruebas de laboratorio. Se revisa la literatura acerca del diagnóstico de las complicaciones neurológicas y se dan recomendaciones actualizadas para el tratamiento de las diversas formas de Neurobrucelosis