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LEWIS-SUMNER SINDROM SA ZNAČAJNIM POBOLJŠANJEM POMOĆU TERAPIJE IMUNOGLOBULINIMA /
LEWIS-SUMNER SYNDROME HAVE SIGNIFICANT IMPROVEMENT WITH IMMUNOGLOBULINS THERAPY

Authors

 

Snežana B. Knežević1 , Bratislav R. Đorđević2 , Ivan Z. Gajović3

1Dom zdravlja Kraljevo, Srbija
2Opšta bolnica ,,Studenica“ Kraljevo, odeljenje Neurologije, Srbija
3Specijalna hirurška bolnica ,,Sveti Nikola“ Ratina, Kraljevo, Srbija

 

UDK: 616.8-085
615.37


The paper was received / Rad primljen: 09.10.2018.

Accepted / Rad prihvaćen: 12.10.2018

 


Correspondence to:


Dr Snežana Knežević
Dom zdravlja, Kraljevo, Srbija
Ul. Jug Bogdanova 110
tel: +38136301723
e-mail: lesta59@yahoo.com

 

 

Sažetak

 

Uvod. Lewis-Sumner sindrom karakteriše asimetrična multifokalna zahvaćenost distalnog senzornog i motornog neurona, predominantno na gornjim ekstremitetima. Najpre vidimo zahvaćenost jednog nerva, koja progredira i simetrično se razvija. Obično je rame prvo zahvaćeno sa kasnijim širenjem duž ruke.
Prikaz bolesnika. Pacijentkinja, stara 53 godine, javila se na pregled zbog slabosti u potkolenicama, hipestezije i parestezija podlaktica i mišićnom slabošću. Na gornjim ekstremitetima motorna snaga snižena, miotatički refleksi ugašeni, muskulatura hipotrofična, postoje senzorni deficiti. Na donjim ekstremitetima motorna snaga snižena. Detaljnim anamnestičkim, kliničkim, laboratorijskim, ehosonografskim i radiološkim pretragama isključeni su paraneoplastični sindrom, paraproteinemične, imunološke, metaboličke, toksične, nasledne i infektivne polineuropatije. Kompjuterizovana tomografija i magnetna rezonanca glave i vrata nisu ukazali na postojanje demijelinizacionih lezija, tumora ili vaskularnih poremećaja. U likvoru je bila prisutna hipeproteinorahija (0,4 g/L). Elektromiografski pregled ukazao na usporenje brzine provođenja, produžene distalne latence, odsustvo F talasa i blokove provođenja. Biopsija suralisa je potvrdila multifokalnu demijelinizaciju. Idiopatska multifokalna stečena demijelinizaciona senzorna i motorna neuropatija je na terapiju kortikosteroidima bila bez odgovora pa su primenjeni intravenski imunoglobulini, što je dovelo do poboljšanja. Povoljan terapijski odgo­vor je u skladu sa činjenicom da imunoglobulini predstavljaju lek izbora za ovaj sindrom.

 

 

Ključne reči:

Hronična inflamatorna demijelinizaciona poliradikuloneuropatija, trnjenje, demijelinizacione bolesti, imunoglobulini

 

 

 

Abstract

 

Introduction. Lewis-Sumner syndrome is characterized by an asymmetric multifocal coverage of the distal sensory and motor neuron, predominantly on the upper extremities. Primarily we see the coverage of one nerve, which progresses and develops symmetrically. Usually the shoulder is affected at first, with later spreading along the arm.
Case report. The patient, 53 years of age, arrived at the clinic due to weakness of the shins, numbness and annealing, as well as numbness and muscle weakness in the forearms. Motor strength on the upper extremities reduced, myotatic reflexes are off, musculature hypotrophic. On the lower extremities, motor strength is reduced.
Detailed anamnestic, clinical, laboratory, echosonographic and radiological investigations exclude paraneoplastic syndrome, paraproteinemic, immunological, metabolic, toxic, hereditary and infectious polyneuropathies. Computerized tomography and magnetic resonance of the head and neck did not indicate the presence of demyelinating lesions, tumors or vascular disorders. Lumbar puncture shows increased levels of protein (0,4 g/L). Electromyographic examination shows lower speed, extended distal latence, absence of F waves and conduction blocks. Biopsy of the Suralis nerve shows a multifocal demyelination. Idiopathic multifocal acquired demyelinating sensory and motor neuropathy on corticosteroid therapy had no response, so intravenous immunoglobulins were enforced, which led to improvement.

 

 

Key words:

chronic inflammatory demyelinating polyradiculoneuropathy, paresthesia, demyelinating diseases, immunoglobulins.

 

 

 

References:

 

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PDF Knežević B.S. et al. • MD-Medical Data 2018;10(4): 201-204

 

 

 

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