Mieloses funiculares considerações a propósito de 110 casos

Canelas, Horacio Martins

doi:10.1590/S0004-282X1960000200001

Resumos

O autor, revendo o conceito atual da etiopatogenia das mieloses funiculares, conclui que, na determinação do processo desmielinizante, além da carência de vitamina B12 e da acloridria gástrica, participam outros fatores, carenciais e/ou alérgicos. Baseado no estudo de 110 casos com lesões gástricas constitucionais (100 casos) ou adquiridas (10 casos), o autor discute o problema do diagnóstico. São consideradas as síndromes periférica, funicular dorsal, "piramidal" e encefálica. É ressaltada a importância do exame da sensibilidade vibratória, particularmente por método quantitativo, que revelou, em elevada percentagem dos casos, distúrbios da palestesia também nas mãos. Entre os exames complementares, é salientado o valor do hemograma, do mielograma, da dosagem da acidez gástrica, da determinação da absorção da vitamina B12 radioativa; são também consideradas as alterações electrencefalográficas e do liqüido cefalorraqueano. Os resultados terapêuticos em 44 casos são avaliados através do estudo semiquantitativo da sintomatologia neurológica. Embora a vitamina B12 tenha proporcionado maiores índices de melhora, os demais medicamentos (extrato hepático, ácido fólico e adrenocorticotropina) também influenciaram favoravelmente o quadro neurológico. Em vista da pequena representação numérica da casuística nos grupos correspondentes aos quatro esquemas terapêuticos, o autor não emite conclusão definitiva. Salienta, porém, que êsses resultados demonstram a necessidade de prosseguir nos estudos sôbre a etiopatogenia das mieloses funiculares, no sentido de esclarecer as numerosas incógnitas que ainda perduram.

After a review on the present concept of the etiopathogenesis of funicular myelosis (subacute combined degeneration of the spinal cord) the author states the conclusion that in the causation of the demyelinating process, besides the lack of vitamin B]2 and gastric achlorhydria, other deficiency or allergic factors take part. Based on the study of 110 cases with constitutional (100 cases) or acquired (10 cases) gastric lesions, the author discusses the problem of the diagnosis. Peripheral, dorsal funicular, "pyramidal", and encephalic syndromes are considered. The importance of the examination of the vibration sense, particularly by quantitative methods, is emphasized; in a great percentage of cases, disturbances of this sensation were also disclosed in the upper limbs. Among the laboratory findings, the value of blood count, bone-marrow smear, gastric acidity analysis, and the study of absorption of radioactive vitamin B12 is stressed. Changes in the electroencephalogram and cerebrospinal fluid are also considered. Therapeutic results in 44 cases are estimated by the semi-quantitative study of the neurological signs. Although vitamin B12 displayed higher degree of improvement, the other drugs (liver extract, folic acid and adreno-corticotropin) have also influenced favorably the neurological manifestations. Owing to the low numerical representation of cases in the groups corresponding to the four schemes of treatment, the author does not state a definite conclusion. But he emphasizes that these results demonstrate the need of further studies on the etiopathogenesis of funicular myelosis, in an attempt to settle the several questions still unsolved.

Horacio Martins Canelas

Assistente-Docente de Clínica Neurológica da Fac. Med. da Univ. de São Paulo

RESUMO

O autor, revendo o conceito atual da etiopatogenia das mieloses funiculares, conclui que, na determinação do processo desmielinizante, além da carência de vitamina B₁₂ e da acloridria gástrica, participam outros fatores, carenciais e/ou alérgicos.

Baseado no estudo de 110 casos com lesões gástricas constitucionais (100 casos) ou adquiridas (10 casos), o autor discute o problema do diagnóstico. São consideradas as síndromes periférica, funicular dorsal, "piramidal" e encefálica. É ressaltada a importância do exame da sensibilidade vibratória, particularmente por método quantitativo, que revelou, em elevada percentagem dos casos, distúrbios da palestesia também nas mãos. Entre os exames complementares, é salientado o valor do hemograma, do mielograma, da dosagem da acidez gástrica, da determinação da absorção da vitamina B₁₂ radioativa; são também consideradas as alterações electrencefalográficas e do liqüido cefalorraqueano.

Os resultados terapêuticos em 44 casos são avaliados através do estudo semiquantitativo da sintomatologia neurológica. Embora a vitamina B₁₂ tenha proporcionado maiores índices de melhora, os demais medicamentos (extrato hepático, ácido fólico e adrenocorticotropina) também influenciaram favoravelmente o quadro neurológico. Em vista da pequena representação numérica da casuística nos grupos correspondentes aos quatro esquemas terapêuticos, o autor não emite conclusão definitiva. Salienta, porém, que êsses resultados demonstram a necessidade de prosseguir nos estudos sôbre a etiopatogenia das mieloses funiculares, no sentido de esclarecer as numerosas incógnitas que ainda perduram.

SUMMARY

After a review on the present concept of the etiopathogenesis of funicular myelosis (subacute combined degeneration of the spinal cord) the author states the conclusion that in the causation of the demyelinating process, besides the lack of vitamin B_]2 and gastric achlorhydria, other deficiency or allergic factors take part.

Based on the study of 110 cases with constitutional (100 cases) or acquired (10 cases) gastric lesions, the author discusses the problem of the diagnosis. Peripheral, dorsal funicular, "pyramidal", and encephalic syndromes are considered. The importance of the examination of the vibration sense, particularly by quantitative methods, is emphasized; in a great percentage of cases, disturbances of this sensation were also disclosed in the upper limbs. Among the laboratory findings, the value of blood count, bone-marrow smear, gastric acidity analysis, and the study of absorption of radioactive vitamin B₁₂ is stressed. Changes in the electroencephalogram and cerebrospinal fluid are also considered.

Therapeutic results in 44 cases are estimated by the semi-quantitative study of the neurological signs. Although vitamin B₁₂ displayed higher degree of improvement, the other drugs (liver extract, folic acid and adreno-corticotropin) have also influenced favorably the neurological manifestations. Owing to the low numerical representation of cases in the groups corresponding to the four schemes of treatment, the author does not state a definite conclusion. But he emphasizes that these results demonstrate the need of further studies on the etiopathogenesis of funicular myelosis, in an attempt to settle the several questions still unsolved.

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104. ZEMAN, W.; DeLAND, F. H. - Contribution to the pathogenesis of subacute combined degeneration of the spinal cord. Report of two cases. Am. J. Clin. Path., 28:515-523 (novembro) 1957.

Trabalho apresentado à Academia de Medicina de São Paulo

Clínica Neurológica - Hospital das Clínicas da Fac. Meã. da Univ. de São Paulo - Caixa Postal 3461 - São Paulo, Brasil

1. ADAMS, J. F.; TIMBURY, G. C. - Subacute combined degeneration developing during liver therapy. Brit. M. J., i:833-834 (28 março) 1959.
2. AHRENS, R. S. - Neurological aspects of primary anemia. Arch. Neurol, a. Psychiat., 28:92-111 (julho) 1932.
3. ALBAHARY, C. - Anémie de Biermer et gastrectomie partielle. Presse Méd., 63:23-24 (8 janeiro) 1955.
4. ALEXANDER, L. - New concept of critical steps in course of chronic debilitating neurologic disease in evaluation of therapeutic-response. Arch. Neurol, a. Psychiat., 66:253-271 (setembro) 1951.
5. ARIAS, I. M.; APT, L.; POLLYCOVE, M. - Absorption of radioactive vitamin B₁₂ in non-anemic patients with combined-system disease. New England J. Med., 253:1005-1010 (8 dezembro) 1955.
6. AUSTREGÉSILO, A. - Mieloses funiculares. Arq. Brasil. Neurol, e Psiquiat., 17:299-319 (setembro-outubro) 1934.
7. BADENOCH, J. - The use of labelled vitamin B₁₂ and gastric biopsy in the investigation of anaemia. Proc. Roy. Soc. Med., 44:426-427, 1954.
8. BADENOCH, J.; BEDFORD, P. D.; EVANS, J. R. - Massive diverticulosis of the small intestine with steatorrhoea and megaloblastic anaemia. Quart. J. Med., 24:321-330 (outubro) 1955.
9. BADENOCH, J.; EVANS, J. R.; RICHARDS, W. C. D.; WITTS, L. J. - Megaloblastic anaemia following partial gastrectomy and gastro-enterostomy. Brit. J. Haematol., 1:339-344, 1955.
10. BAS-TRUP-MADSEN, P. - Non-anaemic neuropathy due to deficiency of anti-perniciousanaemia principle. Acta Psychiat. et Neurol. Scandinav., supl. 108:35-46, 1956.
11. BERLIN, R.; BERLIN, H.; BRANTE, G.; SJOBERG, S. G. - Failures in long-term oral treatment of pernicious anemia with B₁₂-intrinsic factor preparations. Acta Med. Scandinav., 161:143-160, 1958.
12. BJÖRKENHEIM, G. - a) Neurological changes in pernicious tapeworm anaemia. Acta Med. Scandinav., supl. 260, 1951.
b) Influence of folic acid on the nervous system in pernicious anaemia. Experiences relating to pernicious tapeworm anaemia. Ácta Med. Scandinav., 145:406-409, 1953.
13. BOUDIN, G.r BARBIZET, J.; LABET, R. - Les neuropathies achyliques. Rev. Neurol., 91:361-366 (maio) 1954.
14. CALLENDER, S. T.; LAJTHA, L. G. - On the nature of Castle's hemopoietic factor. Blood, 6:1234-1239 (dezembro) 1951.
15. CANELAS, H. M. - a) Distúrbios neurológicos nos estados carenciais aquílicos. Arq. Neuro-Psiquiat., 10:1-40 (março) 1952.
b) Sensibilidade vibratória: valor semiótico em algumas afecções do sistema nervoso. Arq. Neuro-Psiquiat., 16:275-352 (dezembro) 1958.
16. CANELAS, H. M.; JAMRA, M. A. - Estudo comparativo dos efeitos hematológicos e neurológicos do extrato hepático, ácido fólico e vitamina B₁₂ no tratamento da anemia perniciosa de Addison-Biermer. Arq. Neuro-Psiquiat., 11: 229-246 (setembro) 1953.
17. CANELAS, H. M.; LEVY, J. A. - a) Resultados pre- liminares do emprêgo do ACTH nas degenerações combinadas da medula. Arq. JNeuro-Psiquiat., 11:253-258 (setembro) 1953.
b) Tratamento das neuropatías desmielinizantes aquílicas pelo ACTH. Resultados imediatos e tardios. Arq. Neuro-Psiquiat., 13:296-302 (dezembro) 1955.
18. CASTLE, W. B. - Development of knowledge concerning the gastric intrinsic factor and its relation to pernicious anemia. New England J. Med., 249:603-614 (8 outubro) 1953.
19. CHANARIN, I.; MOLLIN, D. L.; ANDERSON, B. B. - The clearance from the plasma of folic acid injected intravenously in normal subjects and patients with megaloblastic anaemia. Brit. J. Haematol., 4:435-446 (outubro) 1958.
20. CONLEY, C. L.; KREVANS, J. R. - New developments in the diagnosis and treatment of pernicious anemia. Ann. Int. Med., 43:758-766 (outubro) 1955.
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Mieloses funiculares considerações a propósito de 110 casos

Subacute combined degeneration of the spinal cord: an analysis of one hundred and ten cases

Datas de Publicação

Publicação nesta coleção
10 Dez 2013
Data do Fascículo
Jun 1960

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADAMS, J. F.; TIMBURY, G. C. - Subacute combined degeneration developing during liver therapy. Brit. M. J., i:833-834 (28 março) 1959.

[2] 2. AHRENS, R. S. - Neurological aspects of primary anemia. Arch. Neurol, a. Psychiat., 28:92-111 (julho) 1932.

[3] 3. ALBAHARY, C. - Anémie de Biermer et gastrectomie partielle. Presse Méd., 63:23-24 (8 janeiro) 1955.

[4] 4. ALEXANDER, L. - New concept of critical steps in course of chronic debilitating neurologic disease in evaluation of therapeutic-response. Arch. Neurol, a. Psychiat., 66:253-271 (setembro) 1951.

[5] 5. ARIAS, I. M.; APT, L.; POLLYCOVE, M. - Absorption of radioactive vitamin B₁₂ in non-anemic patients with combined-system disease. New England J. Med., 253:1005-1010 (8 dezembro) 1955.

[6] 6. AUSTREGÉSILO, A. - Mieloses funiculares. Arq. Brasil. Neurol, e Psiquiat., 17:299-319 (setembro-outubro) 1934.

[7] 7. BADENOCH, J. - The use of labelled vitamin B₁₂ and gastric biopsy in the investigation of anaemia. Proc. Roy. Soc. Med., 44:426-427, 1954.

[8] 8. BADENOCH, J.; BEDFORD, P. D.; EVANS, J. R. - Massive diverticulosis of the small intestine with steatorrhoea and megaloblastic anaemia. Quart. J. Med., 24:321-330 (outubro) 1955.

[9] 9. BADENOCH, J.; EVANS, J. R.; RICHARDS, W. C. D.; WITTS, L. J. - Megaloblastic anaemia following partial gastrectomy and gastro-enterostomy. Brit. J. Haematol., 1:339-344, 1955.

[10] 10. BAS-TRUP-MADSEN, P. - Non-anaemic neuropathy due to deficiency of anti-perniciousanaemia principle. Acta Psychiat. et Neurol. Scandinav., supl. 108:35-46, 1956.

[11] 11. BERLIN, R.; BERLIN, H.; BRANTE, G.; SJOBERG, S. G. - Failures in long-term oral treatment of pernicious anemia with B₁₂-intrinsic factor preparations. Acta Med. Scandinav., 161:143-160, 1958.

[12] 12. BJÖRKENHEIM, G. - a) Neurological changes in pernicious tapeworm anaemia. Acta Med. Scandinav., supl. 260, 1951.

[13] b) Influence of folic acid on the nervous system in pernicious anaemia. Experiences relating to pernicious tapeworm anaemia. Ácta Med. Scandinav., 145:406-409, 1953.

[14] 13. BOUDIN, G.r BARBIZET, J.; LABET, R. - Les neuropathies achyliques. Rev. Neurol., 91:361-366 (maio) 1954.

[15] 14. CALLENDER, S. T.; LAJTHA, L. G. - On the nature of Castle's hemopoietic factor. Blood, 6:1234-1239 (dezembro) 1951.

[16] 15. CANELAS, H. M. - a) Distúrbios neurológicos nos estados carenciais aquílicos. Arq. Neuro-Psiquiat., 10:1-40 (março) 1952.

[17] b) Sensibilidade vibratória: valor semiótico em algumas afecções do sistema nervoso. Arq. Neuro-Psiquiat., 16:275-352 (dezembro) 1958.

[18] 16. CANELAS, H. M.; JAMRA, M. A. - Estudo comparativo dos efeitos hematológicos e neurológicos do extrato hepático, ácido fólico e vitamina B₁₂ no tratamento da anemia perniciosa de Addison-Biermer. Arq. Neuro-Psiquiat., 11: 229-246 (setembro) 1953.

[19] 17. CANELAS, H. M.; LEVY, J. A. - a) Resultados pre- liminares do emprêgo do ACTH nas degenerações combinadas da medula. Arq. JNeuro-Psiquiat., 11:253-258 (setembro) 1953.

[20] b) Tratamento das neuropatías desmielinizantes aquílicas pelo ACTH. Resultados imediatos e tardios. Arq. Neuro-Psiquiat., 13:296-302 (dezembro) 1955.

[21] 18. CASTLE, W. B. - Development of knowledge concerning the gastric intrinsic factor and its relation to pernicious anemia. New England J. Med., 249:603-614 (8 outubro) 1953.

[22] 19. CHANARIN, I.; MOLLIN, D. L.; ANDERSON, B. B. - The clearance from the plasma of folic acid injected intravenously in normal subjects and patients with megaloblastic anaemia. Brit. J. Haematol., 4:435-446 (outubro) 1958.

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