Assuntos
Agnosia/etiologia , Hemiplegia/etiologia , Acidente Vascular Cerebral/complicações , Idoso de 80 Anos ou mais , Agnosia/psicologia , Aspirina/uso terapêutico , Conscientização , Feminino , Fibrinolíticos/uso terapêutico , Hemiplegia/psicologia , Humanos , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/psicologia , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
A 31-year-old man had optic neuritis 2 weeks after a diarrheal illness, followed by several deficits including palatal dysarthria, diplopia, ataxia, sensory dysfunction, and mild dysautonomia. Brain MRI and CSF were normal. Nerve conduction studies were initially normal and subsequently showed mild reduction in sensory amplitudes. Anti-GQ1b IgG titer was positive. Deficits resolved after treatment with IVIg. This clinical constellation represents an overlap between Miller Fisher syndrome (MFS) and the pharyngeal-cervical-brachial (PCB) variant of Guillain-Barre syndrome (GBS), along with the infrequently reported central feature of optic neuritis. Campylobacter jejuni enteritis may have triggered the syndrome by molecular mimicry. GQ1b antibodies are associated with MFS, GBS, Bickerstaff brainstem encephalitis and PCB; they form an overlapping spectrum of features, hence the anti-GQ1b syndrome.
Assuntos
Disartria/etiologia , Gangliosídeos/imunologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/imunologia , Neurite Óptica/etiologia , Palato/patologia , Doenças do Nervo Abducente/etiologia , Adulto , Diarreia/etiologia , Disartria/patologia , Humanos , Imunoglobulina G/imunologia , Imageamento por Ressonância Magnética , Masculino , Exame Neurológico , Distúrbios da Fala/etiologiaRESUMO
BACKGROUND: Myasthenia gravis (MG) and neuromyelitis optica (NMO, also known as Devic disease) are rare autoimmune disorders, with upper-limit prevalence estimates in the general population of 15 per 100,000 and 5 per 100,000, respectively. To our knowledge, an association between these diseases has not been previously reported. OBJECTIVES: To describe 4 patients with MG who developed NMO after thymectomy and to analyze possible causes of apparent increased prevalence of NMO among patients with MG. DESIGN: Case series. PATIENTS: Four patients with MG who underwent thymectomy. INTERVENTIONS: None. RESULTS: The prevalence of MG within the published cohort of patients with NMO is more than 150 times higher than that in the general population. CONCLUSION: Dysregulation of B-cell autoimmunity in myasthenia, possibly exacerbated by loss of control over autoreactive cells as a result of thymectomy, may predispose patients to the development of NMO.
