Assuntos
Cefaleia/economia , Cefaleia/terapia , Programas de Assistência Gerenciada/economia , Bloqueio Nervoso/economia , Adulto , Humanos , Revisão da Utilização de Seguros , Masculino , Programas de Assistência Gerenciada/normas , Programas de Assistência Gerenciada/estatística & dados numéricos , Dor Intratável/economia , Dor Intratável/terapia , Revisão dos Cuidados de Saúde por Pares , Revisão da Utilização de Recursos de SaúdeRESUMO
Thirty-eight patients with the primary Sjögren syndrome, 16 with active neuropsychiatric manifestations and 22 without clinical evidence of central nervous system involvement had magnetic resonance (MR) imaging. Eight patients had focal neurologic deficits (6 of these also had psychiatric, or cognitive dysfunction), and 8 had psychiatric or cognitive abnormalities alone. Magnetic resonance imaging showed abnormal results in 12 of 16 (75%; 95% CI, 48 to 93) patients with active central nervous system disease (67 focal lesions predominantly within the subcortical and periventricular white matter), and in 2 of 22 (9%; 95% CI, 1 to 29) patients without clinical evidence of central nervous system disease (P less than 0.0001). Seven of eight patients with focal neurologic deficits and 5 of 8 patients with psychiatric or cognitive dysfunction alone had abnormal results on MR imaging. Magnetic resonance imaging was more sensitive in the subgroup with focal deficits, (sensitivity, 88%; 95% CI, 44 to 97) than computerized axial tomography or cerebral angiography. Magnetic resonance imaging detects focal cerebral lesions in patients with the Sjögren syndrome and central nervous system involvement, including patients with psychiatric and cognitive dysfunction alone.
Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética , Síndrome de Sjogren/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/patologia , Angiografia Cerebral , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/patologia , Feminino , Humanos , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/patologia , Pessoa de Meia-Idade , Síndrome de Sjogren/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Sensory neuropathies, particularly trigeminal neuropathy, have been recognized as neurological complications of Sjögren's syndrome, but the pathogenesis has not been established. We describe a woman with primary Sjögren's syndrome who developed a progressive debilitating subacute sensory neuronopathy. Results of electrophysiological studies were consistent with involvement of the trigeminal and dorsal root ganglia. A thoracic dorsal root ganglion biopsy showed lymphocytic infiltration and degeneration of ganglion cells. We believe that this is the first description of biopsy-documented dorsal root ganglionitis in a subacute sensory neuronopathy associated with Sjögren's syndrome and that the finding suggests an immunopathogenic basis.
Assuntos
Gânglios Espinais , Doenças do Sistema Nervoso Periférico/etiologia , Síndrome de Sjogren/complicações , Feminino , Gânglios Espinais/patologia , Humanos , Pessoa de Meia-Idade , Neurônios Aferentes , Síndrome de Sjogren/patologiaRESUMO
We report three patients who recovered from "locked-in" syndrome of presumed vascular origin. One patient narrated her experience of the "locked-in" phase and its termination. Another demonstrated palatal myoclonus and mirror movements upon recovery. These patients deserve considerate handling and vigorous medical support.
