Focal and multifocal diabetic neuropathies

Diabetic neuropathy is the most common neuropathy in industrialized countries, with a remarkable range of clinical manifestations. The vast majority of the patients with clinical diabetic neuropathy have a distal symmetrical form that progress following a fiber-length dependent pattern, with predominant sensory and autonomic manifestations. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients are exposed to trophic changes in the feet, pains and autonomic disturbances. Less often, diabetic patients may develop focal and multifocal neuropathy that includes cranial nerve involvement, limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, mostly in patients with longstanding diabetes mellitus. The LDDP does not show any trend to improvement and either relentlessly progresses or remain relatively stable over years. Conversely the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self limited, sometimes after a relapsing course.

A neuropatia diabética é a mais predominante das neuropatias nos países industrializados apresentando uma gama variável de manifestações clinicas. A maioria dos pacientes com neuropatia diabética apresenta uma forma simétrica distal que progride para um padrão fibra comprimento dependente com manifestações sensitivas e autonomicas. Este tipo de neuropatia é associado com uma axonopatia distal progressiva. Os pacientes apresentam modificações tróficas nos pés, dores e distúrbios autonômicos. Menos freqüentemente os pacientes diabéticos podem desenvolver neuropatia focal e multifocal que incluem envolvimento de nervos cranianos, tronco e membros inferiores. Este padrão de neuropatia é mais freqüente em pacientes com mais de 50 anos e com longa historia de diabetes. Este tipo de neuropatia fibra-comprimento dependente não apresenta melhora, progride lentamente ou permanece estável por vários anos. As neuropatias focais que são associadas freqüentemente com vasculopatias inflamatórias nas biópsias de nervo, permanecem auto limitadas por vezes com surtos de remissão.

Focal and multifocal diabetic neuropathies.

Diabetic neuropathy is the most common neuropathy in industrialized countries, with a remarkable range of clinical manifestations. The vast majority of the patients with clinical diabetic neuropathy have a distal symmetrical form that progress following a fiber-length dependent pattern, with predominant sensory and autonomic manifestations. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients are exposed to trophic changes in the feet, pains and autonomic disturbances. Less often, diabetic patients may develop focal and multifocal neuropathy that includes cranial nerve involvement, limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, mostly in patients with longstanding diabetes mellitus. The LDDP does not show any trend to improvement and either relentlessly progresses or remain relatively stable over years. Conversely the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self limited, sometimes after a relapsing course.

Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region.

INTRODUCTION: Hepatitis virus C (HCV) infection is considered a health problem in the State of Acre localized in the Brazilian Amazon which has a prevalence rate of 5.9%. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. OBJECTIVE: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. METHOD: A cross sectional study was performed in patients assisted by a specialized center of infectious diseases in the State of Acre. All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). RESULTS: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51% had at least 8 years of formal education and 96% lived in the capital city of Acre State. Roughly 34% of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1%; IC95% 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1%) patients. CONCLUSION: Subclinical involvement of peripheral nerves seems common in patients with HCV, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.

Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region / Neuropatia periférica em pacientes com infecção pelo vírus C da hepatite na região amazônica

INTRODUCTION: Hepatitis virus C (HCV) infection is considered a health problem in the State of Acre localized in the Brazilian Amazon which has a prevalence rate of 5.9 percent. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. OBJECTIVE: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. METHOD: A cross sectional study was performed in patients assisted by a specialized center of infectious diseases in the State of Acre. All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). RESULTS: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51 percent had at least 8 years of formal education and 96 percent lived in the capital city of Acre State. Roughly 34 percent of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1 percent; IC95 percent 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1 percent) patients. CONCLUSION: Subclinical involvement of peripheral nerves seems common in patients with HCV, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.

INTRODUÇÃO: A infecção pelo vírus da hepatite C (VHC) é considerada um problema de saúde pública no Estado do Acre com uma prevalência de 5,9 por cento. Neuropatia periférica é uma manifestação extra-hepática comum em pacientes com VHC. OBJETIVO: Determinar a prevalência de neuropatias periféricas através de parâmetros clínicos e neurofisiológicos. MÉTODO: Foi realizado estudo transversal em pacientes atendidos em uma clínica especializada de doenças infecciosas do Estado do Acre. Todos os pacientes foram submetidos a um questionário clínico-epidemiológico, exame físico e eletroneuromiografia (ENMG). RESULTADOS: Foram estudados 78 pacientes, com idade média de 45,5 anos (10 a 76), dois terços eram do sexo masculino, 51 por cento tinha pelo menos 8 anos de educação formal e 95 por cento moravam na capital do Estado. Aproximadamente 34 por cento dos pacientes se queixaram de parestesias, principalmente nos membros superiores. A ENMG diagnosticou mononeuropatia múltipla em 11 (14,1 por cento, IC95 por cento 7,6-23,2) pacientes e síndrome do túnel do carpo em 4 (5,1 por cento). CONCLUSÃO: Comprometimento dos nervos periféricos é comum em pacientes com VHC, sendo neuropatia múltipla a apresentação mais comumente diagnosticada pela ENMG.

Detection of Mycobacterium leprae in nerve lesions bu the polymerase chain reaction

A simple procedure is described for the detection of Mycobacterium leprae by the polymerase chain reaction in nerve biopsies sectioned with a cryostat and then treated with proteinase K. All samples from lepromatous leprosy patients and the majority of samples from paucibacillary cases yielded positive results. This approach may be useful for differentiating between leprosy and other inflammatory neuropathies.