Dados do Trabalho

Título

The importance of Electroneuromyography in the differential diagnosis of acute flaccid paralysis

RESUMO

Case Report: A 53-year-old hypertensive pharmacist reports that 2 months ago he
began insidiously with bilateral paresthesia associated with mild brachial diparesis. In
the last 2 weeks before admission, patient reports worsening of the condition with
paresis in the 4 limbs, predominantly brachial and proximal. In the evaluation, the
patient was alert, without alterations in the cranial nerves, reduced strength in the
upper limbs (Grade I) and in the proximal segment of the lower limbs (Grade III) and
with areflexia. In the laboratory analysis, the cerebrospinal fluid showed cellularity of
38 (90% lymphomononuclear), proteins of 36 and glucose 70; in serum tests, the only
change was VDRL reagent in the titer of 1/128, when FTA-Abs was requested (which
later turned out to be negative). In the imaging evaluation, cranial and cervical spine
resonance was performed without significant changes. Therefore,
Electroneuromyography (ENMG) was requested and the condition was initially
managed as neurosyphilis, until there was no therapeutic response and ENMG proved to
be a sensory-motor syndrome with a demyelinating pattern. Based on the hypothesis
of Guillain-Barré Syndrome, he underwent treatment with Human Immunoglobulin
and showed significant improvement in the condition, with improvement in sensitivity
and strength in all segments.

Discussion: The use of Electroneuromyography as an auxiliary tool in the diagnosis of
neurological diseases is already a reality. However, ENMG has been shown to be
particularly useful in the diagnostic distinction between acute flaccid paralysis, being a
fundamental element for more adequate therapeutic guidance.

Final Comments: In the same way that complementary exams can, on the one hand,
help the diagnosis, on the other hand, they can delay it due to numerous diagnostic
possibilities that remain open. However, the ENMG, when in correlation with the clinic,
has been shown to be a valuable element in the therapeutic decision

Palavras Chave

Electroneuromyography; Neurosyphilis; Guillain-Barré Syndrome; Acute Flaccid Paralysis