Movimientos anormales identificados en pacientes con tuberculomas intracraneales / Movement disorders identified in patients with intracranial tuberculomas

Introducción: los movimientos involuntarios anormales (MIA) se han asociado con lesiones en estructuras profundas del cerebro. El objetivo del estudio fue describir la frecuencia y características de MIA en pacientes con tuberculomas intracraneales. Métodos: se incluyeron los pacientes ingresados consecutivamente en el Servicio de Neurología del Hospital Eugenio Espejo (Quito-Ecuador) entre 1989 y 2004 con diagnóstico de tuberculomas intracraneales. Todos los pacientes fueron examinados clínicamente, se realizaron exámenes de laboratorio y estudios de imagen. El período de seguimiento se prolongó hasta un año después del tratamiento antituberculoso. Dentro de la cohorte se diferenció dos grupos: casos incidentes con MIA y controles. Se compararon las características clínicas, número y localización de los tuberculomas. Resultados: se estudiaron 49 pacientes (edad media 31,7±20,5 años; sexo masculino 53,1%). Hubo 16 casos incidentes (32,6%; IC 95%=19,9% - 47,5%) de MIA: corea (n=7; 43,8%), temblor (n=5; 31,3%), distonía (n=3; 18,8%) y mioclonías (n=1; 6,3%). La mayoría de casos (87,6%) se desarrollaron tempranamente (10,4±5,2 días de hospitalización). Al ingreso los pacientes con MIA mostraron mayor severidad de la enfermedad que los controles (68,7 vs. 30,3%; p=0,01), tuvieron mayor déficit motor (75,% vs. 39,4%; p=0,01) y sensitivo (43,8 vs. 9.1%; p=0,01). En los casos fueron más frecuentes los tuberculomas múltiples (68,7 vs. 364%), la localización supratentorial profunda (31,3 vs. 21,2%) y las secuelas motoras (25,0 vs. 12,1%). Conclusiones: los resultados sugieren una relación causal entre tuberculomas y MIA. La localización profunda y la presencia de tuberculomas múltiples incrementarían el riesgo para desarrollar MIA (AU)

Introduction: Movement disorders have been associated with deep brain lesions. This study was performed to describe the frequency and characteristics of movement disorders in patients with intracranial tuberculomas. Methods: patients admitted consecutively between 1989 and 2004 to the Neurology Service of Eugenio Espejo Hospital (Quito, Ecuador), with a diagnosis of intracranial tuberculomas. All patients were examined clinically, and laboratory tests and imaging studies performed. Follow-up continued up to one year after the tuberculosis treatment was completed. A nested case-control analysis was performed to compare clinical characteristics, number and location of tuberculomas, between cases with movement disorders and controls. Results: forty-nine patients with tuberculomas (31.7±20.5 years; males 53.1%) were studied. We found 16 cases (32.6%; 95%CI=19.9% - 47.5%) of movement disorders: chorea (n=7; 43.8%), tremor (n=5; 31.3%), dystonia (n=3; 18.8%) and myoclonus (n=1; 6.3%). Most cases (87.6%) developed early (10.4±5.2 days of hospitalization). On admission, patients with movement disorders showed higher severity of the illness than controls (68.7 vs. 30.3%; p=.01), along with greater motor impairment (75.0 vs. 39.4%; p=.01) and sensitivity impairment (43.8 vs. 9.1%; p=.01). The cases showed higher frequency of multiple tuberculomas (68.7 vs. 36.4%), with deep brain deep (31.3 vs. 21.2%) and more severe motor impairment (25.0 vs. 12.1%). Conclusions: our results suggest a causal relationship between tuberculomas and movement disorders. Deep location and multiple tuberculomas may increase the risk of develop movement disorders (AU)

Movement disorders identified in patients with intracranial tuberculomas.

INTRODUCTION: movement disorders have been associated with deep brain lesions. This study was performed to describe the frequency and characteristics of movement disorders in patients with intracranial tuberculomas. METHODS: patients admitted consecutively between 1989 and 2004 to the Neurology Service of Eugenio Espejo Hospital (Quito, Ecuador), with a diagnosis of intracranial tuberculomas. All patients were examined clinically, and laboratory tests and imaging studies performed. Follow-up continued up to one year after the tuberculosis treatment was completed. A nested case-control analysis was performed to compare clinical characteristics, number and location of tuberculomas, between cases with movement disorders and controls. RESULTS: forty-nine patients with tuberculomas (31.7±20.5 years; males 53.1%) were studied. We found 16 cases (32.6%; 95%CI=19.9% - 47.5%) of movement disorders: chorea (n=7; 43.8%), tremor (n=5; 31.3%), dystonia (n=3; 18.8%) and myoclonus (n=1; 6.3%). Most cases (87.6%) developed early (10.4±5.2 days of hospitalization). On admission, patients with movement disorders showed higher severity of the illness than controls (68.7 vs. 30.3%; p=.01), along with greater motor impairment (75.0 vs. 39.4%; p=.01) and sensitivity impairment (43.8 vs. 9.1%; p=.01). The cases showed higher frequency of multiple tuberculomas (68.7 vs. 36.4%), with deep brain deep (31.3 vs. 21.2%) and more severe motor impairment (25.0 vs. 12.1%). CONCLUSIONS: our results suggest a causal relationship between tuberculomas and movement disorders. Deep location and multiple tuberculomas may increase the risk of develop movement disorders.