Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function / Classificação da paralisia cerebral: associação entre gênero, idade, tipo motor, topografia e Função Motora Grossa

The goal of this study was to assess the relation between gender, age, motor type, topography and gross motor function, based on the Gross Motor Function System of children with cerebral palsy. Trunk control, postural changes and gait of one hundred children between 5 months and 12 years old, were evaluated. There were no significant differences between gender and age groups (p=0.887) or between gender and motor type (p=0.731). In relation to body topography most children (88 percent) were spastic quadriplegic. Most hemiplegics children were rated in motor level I, children with diplegia were rated in motor level III, and quadriplegic children were rated in motor level V. Functional classification is necessary to understand the differences in cerebral palsy and to have the best therapeutic planning since it is a complex disease which depends on several factors.

Este estudo teve como objetivo avaliar a relação entre gênero, idade, tipo motor, topografia e Função Motora Grossa, baseado no Sistema de Função Motora Grossa em crianças com paralisia cerebral. Participaram desta pesquisa 100 crianças com idade entre 5 meses a 12 anos que foram observadas em relação ao controle de tronco, trocas posturais e marcha. Não houve diferenças significativas entre gêneros e grupos etários (p=0,887) e entre gênero e tipo motor (p=0,731). Em relação à topografia corporal, houve predomínio de crianças com quadriplegia, sendo que a maioria (88 por cento) era do tipo espástico. Quanto ao nível motor, as crianças hemiplégicas pertenciam em sua maioria ao nível I, as diplégicas ao nível III e as quadriplégicas ao nível V. Sendo a paralisia cerebral uma condição complexa que depende de diversos fatores, beneficia-se de classificações funcionais para compreensão da diversidade e melhor planejamento terapêutico.

Abductor pollicis longus deviation graft operation: modified for stabilizing CMC and MCP joints of 'intrinsic minus' thumb.

The original procedure abductor pollicis longus deviation graft operation by Beine (1996) was introduced to correct retroposition of the thumb and to balance the instability at the carpometacarpal (CMC) joint in cases of ulnar-cum-low median palsy in leprosy, so that bone-using procedures can be avoided to some extent. It provides an antagonistic force to the action of the abductor pollicis longus (abd. pol. long.) by giving this muscle a second insertion, with the result that the action of the abd. pol. long. now stabilises to a considerable extent the CMC joint in its mid-rotational position by a partial replacement of the action of the opponens pollicis (opp. pol.) and abductor pollicis brevis (abd. pol. brev.). Experience over five years with the original procedure showed us that it can make an ulnar deviation more visible at the MCP joint of the thumb. The modification of the procedure corrects this as well, as the results in 12 hands of 11 patients have shown. Interestingly, of the 11 patients who underwent operation, one was not a leprosy patient, but referred to us for partial triple palsy of the left hand and arm without sensory loss. It is shown that the indication of this procedure is wider than mentioned earlier.

Mechanics of tarsal disintegration and plantar ulcers in leprosy by stress analysis in three dimensional foot models.

This paper describes three dimensional two arch models of feet of a normal subject and two leprosy subjects, one in the early stage and the other in the advanced stage of tarsal disintegration, used for analysis of skeletal and plantar soft tissue stresses by finite element technique using NISA software package. The model considered the foot geometry (obtained from X-rays), foot bone, cartilages, ligaments, important muscle forces and sole soft tissue. The stress analysis is carried out for the foot models simulating quasi-static walking phases of heel-strike, mid-stance and push-off. The analysis of the normal foot model shows that highest stresses occur at push-off over the dorsal central part of lateral and medial metatarsals and dorsal junction of calcaneus and cuboid and neck of talus. The skeletal stresses, in early state leprosy with muscle paralysis and in the advanced stage of tarsal distintegration (TD), are higher than those for the normal foot model, by 24% to 65% and 30% to 400%, respectively. The vertical stresses in the soft tissue at the foot-ground interface match well with experimentally measured foot pressures and for the normal and leprosy subjects they are the highest in the push-off phase. In the leprosy subject with advanced TD, the highest soft tissue stresses and shear stresses (about three times the normal value) occur in push-off phase in the scar tissue region. The difference in shear stresses between the sole and the adjacent soft tissue layer in the scar tissue for the same subject is about three times the normal value. It is concluded that the high bone stresses in leprosy may be responsible for tarsal distintegration when the bone mechanical strength decreases due to osteoporosis and the combined effect of high value of footsole vertical stresses, shear stresses and the relative shear stresses between two adjacent soft tissue layers may be responsible for plantar ulcers in the neuropathic leprosy feet.

Parálisis periódica hipokalémica tirotóxica

Se describe el cuadro clínico de un hombre de 35 años, sin antecedentes personales o familiares de importancia, que ingresa con un día de evolución de debilidad muscular ascendente en miembros inferiores, malestar general, vómito y palpitaciones. Al exámen físico se encuentra taquicárdico, con exoftalmos bilateral, se palpa un nódulo tiroideo derecho; se evidencia disminución de la fuerza muscular en extremidades y arreflexia. El laboratorio reporta hipokalemia (potasio 1.7 mEq/L) e hipertiroidismo (T4 libre 4.05 mg/dl y TSH 0.0 mU/L). Se realiza manejo con clururo de potasio, propanolol y metimazol con rápida resolución de su parálisis flácida. La parálisis hipokalémica es una rara complicación del hipertiroidismo. la mayoria de casos reportados en la litertura mundial provienen de paises asiáticos. la corección de la función tiroidea es esencial para el tratamiento de la hipokalemia

Neuro-Behcet's disease presenting with isolated unilateral lateral rectus muscle palsy

The authors present the clinical findings of a 30-year-old female and a 29-year-old male who both had isolated unilateral lateral rectus muscle palsy in neuro-Behcet's disease. The clinical feature related to isolated abduscens nerve palsy was identified by CT, systemic assessment and extraocular examination. These patients' constellation of findings appear to be unique: it does not follow any previously reported pattern of ocular manifestations of neuro-Behcet's disease.

Isolated bilateral abducens nerve palsy due to carotid cavernous dural arteriovenous fistula

Carotid cavernous dural arteriovenous fistula (DAVF) usually presents with conjunctival injection, proptosis, loss of visual acuity and ophthalmoplegia. There have been some carotid cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We experienced a patient presenting with bilateral abducens nerve palsy and no other ocular signs who was diagnosed as carotid cavernous DAVF after conventional angiography. According to this case, carotid cavernous DAVF should be considered in the differential diagnosis of isolated bilateral abducens nerve palsy, in which case conventional angiography may be helpful in diagnosis.

Parálisis atrial persistente: reporte de 2 casos / Persistent atrial standstill: report of two cases

La parálisis atrial persistente es una rara condición clínica, caracterizada por ausencia de actividad eléctrica y mecánica del atrio, así como la incapacidad de responder a estímulos eléctricos. A partir de la introducción del mapeo intraatrial se logró demostrar la existencia de formas totales y parciales. Se presenta en tres grupos de pacientes: aquéllos con una enfermedad cardiaca de larga evolución, los portadores de algún tipo de distrofia muscular y los con formas aisladas. En la presente revisión se reportan dos casos. Uno, en el que se demostró parálisis atrial total asociado con cardiopatía dilatada. El segundo, con cardiopatía reumática inactiva, en el que se demostró parálisis atrial parcial, que incluyó sólo el tercio apical del atrio derecho. Se presenta el comportamiento clínico y electrofisiológico de ambos pacientes y se hace una revisión de los trabajos recientemente publicados en relación al tema

Residual poliomyelitis of lower limb-pattern and deformities.

The pattern of muscle paralysis and paresis in the lower limbs has been studied in 1356 children with 1800 poliomyelitic limbs, revealed that more than two-third (68 = 55%) muscles were affected, with the ratio of paresis and paralysed muscles were 1.89:1.00. The muscles most frequently affected were tibialis anterior (1516), quadriceps (1465) and tibialis posterior (1435) while tibialis anterior (1070), tibialis posterior (820) and quadriceps (766) were most commonly paralysed in descending order. The tibialis anterior which leads in paralysis group, has come last in order of frequency of paresis. The highest segmental incidence of affection of muscles found in second to fourth lumbar segments while muscle paralysis is found in fourth lumbar spinal segment. The commonest deformities encountered in residual poliomyelitis are flexion-abduction contracture hip, flexion contracture knee and valgus deformity foot.

Intracerebral small vessels disease: the pseudobulbar palsy revisited

De un total de 1590 pacientes con enfermedad cerebrovascular, 61 (3.8%) mostraron parálisis suprabulbar: forma típica 42 pacientes, 2 de estos con anatomía patológica; forma estriada 19 pacientes, 3 con anatomía patológica. Se consideraron también 25 pacientes con síndrome palido-piramidad ya que la presentación clínica parece bordear a la forma estriada. La variedad típica se caracterizó por los siguientes signos fundamentales: disartria, disfagia, disociación automático/voluntaria de movimientos faciales. En la mitad de los casos se asociaron hemiparesia, reflejos primitivos, marcha de pequeños pasos. En la forma estriada los signos fundamentales fueron: disartria, disfagia, disociación automático/voluntaria, rigidez e hipokinesia. Se asociaron reflejos tendinosos vivos, reflejos primitivos, marcha de pequeños pasos y deterioro mental en la mitad de los casos. La variedad típica es producida por infartos multiples y/o lacunares (85.7%) mientras que la forma estriada mostró lesiones vasculares en la TC solo en el 36.8%de los casos. Los hallazgos histológicos (lipohialinosis de la pared arterial con estenosis y oclusión secundarias y rarefacción y desintegración tisular), sugieren que los microinfartos, a veces sólo confirmados por exámen patológico, son el factor patogénico mas importante en esta forma. Hipertensión arterial, cardiopatías, tabaquismo, dislipemia y diabetes son los factores de riesgo más frecuentes en ambas formas. Se concluye que la enfermedad de pequeños vasos intracerebrales puede manifestarse con diferentes cuadros clínicos representados principalmente por parálisis suprabulbar, síndrome palido-piramidal y demencia multilacunar

Parálisis periódica hipokalémica e hipertiroidismo / Hypokalemic periodic paralysis and hypertiroidism

Comunicamos cuatro casos de Parálisis Periódica Hipokalémica asociada a Hipertiroidismo (Enfermedad de Graves*Basedow). Los paroxismos de tetraplejía flácida sin compromiso sensitivo, respiratorio, ni de la conciencia, revirtieron espontáneamente y no se repitieron después de lograr el estado eutiroideo. El potasio sérico se encontró disminuido durante la crisis. La Parálisis Periódica Hipokalémica Tirotóxica tiene peculariedades epidemiológicas, clínicas y metabólicas, que la distinguen de la forma familiar

Parálisis auricular permanente: informe de dos casos con diferente respuesta a la estimulación auricular / Permanent atrial standstill: report of 2 cases with different response to atrial stimulation

Se describen dos casos claramente documentados de parálisis auricular permanante, quienes llenaron los criterios diagnósticos establecidos de ausencia de actividad eléctrica y mecánica de las aurículas. Se discute la importancia de la respuesta a la estimulación auricular y del origen del ritmo de escape en el contexto de un proceso grave, evolutivo y probablemente irreversible

Alteraçöes neurológicas incomuns na paralisia muscular hipocalêmica: relato de um caso / Uncommon neurologic changes in the hypokalemic muscular paralysis: report of a case

Os autores descrevem um paciente com tetraplegia sensitivo motora, com nível sensitivo em C5, arreflexia profunda de membros superiores (MSs)e hiperreflexia profunda de membros inferiores (MIs), de 48 horas de duraçäo associada à hipocalemia e miopatia com histologia compatível com paralisia muscular periódica e revisam a literatura