Reabilitação física na Paraparesia Espástica por deficiência de vitamina B12:
relato de caso
DOI:
https://doi.org/10.34024/rnc.2008.v16.8639Palavras-chave:
Paraparesia Espástica, Degeneração Combinada, Subaguda, Deficiência de Vitamina B12, FisioterapiaResumo
A deficiência de vitamina B12 manifesta-se através de distúrbios neurológicos, psiquiátricos, gastrointestinais e hematológicos. É mais freqüente entre idosos, vegetarianos e indivíduos que adotam baixa dieta protéica ou apresentam distúrbios da absorção gastrintestinal. Sua prevalência é próxima a 20% na população geral, tendo como causa mais freqüente a anemia perniciosa. A degeneração combinada subaguda (DCS), é uma das manifestações neurológicas mais freqüentes na deficiência de vitamina B12, sendo marcada por lesões nas colunas posteriores e laterais, que acarretam déficits sensoriais e motores. Relatamos o caso de um paciente com degeneração subaguda combinada e revisamos a literatura acerca das principais estratégias fisioterapêuticas empregadas na reabilitação de pacientes acometidos por essa condição patológica.
Referências
Russel JSR, Batten FE, Collier J. Subacute combined degeneration of the spinal cord. Brain 1900;10:849-50. DOI: https://doi.org/10.1093/brain/23.1.39
Yousry TA, Strupp M, Brüning R. Common variable immunodeficiency leading to spinal subacute combined degeneration monitored by MRI. J Neurol Neurosurg Psychiatr 1998;64:663-6. DOI: https://doi.org/10.1136/jnnp.64.5.663
Hemmer B, Glocker FX, Schumacher M, Deuschl G, Lücking CH. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatr 1998;65:822-7. DOI: https://doi.org/10.1136/jnnp.65.6.822
Nogales-Gaete J, Jiménez PP, García PF, Sáez DM, Aracena RC, González JV, et al. Mielopatía por déficit de vitamina B12: caracterización clínica de 11 casos. Rev Med Chile 2004;132:1377-82. DOI: https://doi.org/10.4067/S0034-98872004001100006
Paniz C, Grotto D, Schmitt GC, Valentini J, Schott KL, Pomblum VJ, et al. Fisiopatologia da deficiência de vitamina B12 e seu diagnóstico laboratorial. J Bras Patol Med Lab 2005;41(5):323-34. DOI: https://doi.org/10.1590/S1676-24442005000500007
Healton EB, Savage DG, Brust JCM, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine 1991;70:229-45. DOI: https://doi.org/10.1097/00005792-199107000-00001
Medical Research Council. Aids to the examination of the peripheral nervous system. Edinburgh: WB Saunders, 2000, 1-2.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67:206-7. DOI: https://doi.org/10.1093/ptj/67.2.206
Vasconcellos LFR, Corrêa RB, Chimelli L, Nascimento F, Fonseca AB, Nagel J, et al. Mielopatia por deficiência de vitamina B12 apresentando-se como mielite transversa. Arq Neuropsiquiatr 2002;60(1):150-4. DOI: https://doi.org/10.1590/S0004-282X2002000100028
Capdevilla AM, Gorjón E, Romero, J, Moreno MA, Escriche D. Degeneratión combinada subaguda sin anemia. Rev Neurol 2000;30:797.
Behrens MI, Díaz V, Vásquez C, Donoso A. Demencia por déficit de vitamina B12. Caso clínico. Rev Med Chile 2003;131:915-9. DOI: https://doi.org/10.4067/S0034-98872003000800012
Cornejo W, González F, Toro ME, Cabrera D. Degeneración combinada subaguda. Descripción de un caso en un niño vegetariano estricto. Rev Neurol 2001;33(12):1154-7.
Pant SS, Asbury AK, Richardson EP. The myelopathy of pernicious anemia: a neuropathological reappraisal. Acta Neurol Scand 1968;44(Suppl 35):1-36.
Silva MTT, Cavalcanti JL S, Moreira DM. Alterações neurorradiológicas cerebrais na degeneração combinada de medula. Arq Neuropsiquiatr 2000;58:752-5. DOI: https://doi.org/10.1590/S0004-282X2000000400026
Beltramello A, Puppini G, Cerini R, El-Dalati G, Manfredi M, Roncolato G, et al. Subacute combined degeneration of the spinal cord after nitrous oxide anaesthesia: role of magnetic resonance imaging. J Neurol Neurosurg Psychiatr 1998;64:563-4. DOI: https://doi.org/10.1136/jnnp.64.4.563
Carmel R. Measuring and interpreting holo-transcobalamin (holotranscobalamin II). Clin Chem 2002;48(3):407-9. DOI: https://doi.org/10.1093/clinchem/48.3.407
Kwok MD, Cheng G, Lai W, Poon P, Woo J, Pang C. Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons. Nutrition 2004;20(9):764-8. DOI: https://doi.org/10.1016/j.nut.2004.06.001
Andres E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004;171(3):251-9. DOI: https://doi.org/10.1503/cmaj.1031155
Epstein FH. Pernicious anemia. New Engl J Med 1997;337(20):1441-8. DOI: https://doi.org/10.1056/NEJM199711133372007
Cheng SH, Chang MH, Soong BW, Chen CW, Lee YC. Spastic paraparesis as a manifestation of metabolic vitamin B12 deficiency: a case report. J Neurol 2005;252(9):1125-6. DOI: https://doi.org/10.1007/s00415-005-0806-z
Richardson EP, Girolani U. Pathology of the peripheral nerve. In: Li Volsi V (ed.). Major Problems in Pathology. Vol. 32. Philadelphia: WB Saunders, 1995, 176 p.
Kayser-Gatchalan MC, Neundörfer B. Peripheral neuropathy with vitamin B12 deficiency. J Neurol 1997;214:183-97. DOI: https://doi.org/10.1007/BF00316149
Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician. Arch Intern Med 1999;159:1289-98. DOI: https://doi.org/10.1001/archinte.159.12.1289
Hirsch S, De La Maza P, Barrera G, Gattás V, Peterman M, Bunout D. The Chilean flour folic acid fortification program reduces serum homocysteine levels and masks vitamin B12 deficiency in elderly people. J Nutr 2002; 132:289-91. DOI: https://doi.org/10.1093/jn/132.2.289
Bassi SS, Bulundwe KK, Greeff GP, Labuscagne JH, Gledhill RF. MRI of the spinal cord in myelopathy complicating vitamin B12 deficiency: two additional cases and a review of the literature. Neuroradiology 1999;41:271-4. DOI: https://doi.org/10.1007/s002340050746
Pittock SJ, Payne TA, Harper CM. Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency. Mayo Clin Proc 2002;77:291-4. DOI: https://doi.org/10.4065/77.3.291
Bradley WG, Daroff R, Fenichel G, Marsden CD. Neurology in clinical practice. 3rd ed. Boston: Butterworth Heinemann, 2000, 1495-509. Penas M, Blanco A, Villarejo A, Juntas R, Miranda P, Martínez A.
Degeneración combinada subaguda medular: hallazgos en la resonancia magnética. Neurología 2002;17(8):447-8.
Brieva L, Ara JR, Bertol V, Canellas A, del Agua C. Polineuropatía por déficit de vitamina B12 secundaria a gastritis crónica atrófica y giardiasis. Rev Neurol 1998;26(154):1019-20. DOI: https://doi.org/10.33588/rn.26154.97228
Savage DG, Lindenbaum J. Neurological complications of acquired cobalamin deficiency: clinical aspects. Ballieres Clin Haematol 1995;8:657-78. DOI: https://doi.org/10.1016/S0950-3536(05)80225-2
Mayer M. Neurophysiological and kinesiological aspects of spastic gait: the need for a functional approach. Function Neurol 2002;17(1):11-7.
Walton K. Management of patients with spasticity – A practical approach. Practic Neurol 2003;3:342-53. DOI: https://doi.org/10.1111/j.1474-7766.2003.04-175.x
Teive HAG, Zonta M, Kumagai Y. Tratamento da espasticidade: uma atualização. Arq Neuropsiquiatr 1998;56(4): 852-8. DOI: https://doi.org/10.1590/S0004-282X1998000500025
Umphred DA. Reabilitação neurológica. 4ª ed. São Paulo: Manole, 2004, 1118 p.
Feland JB, Myrer JW, Schulthies SS, Fellingham GW, Measom GW. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther 2001;81(5): 1110-7. DOI: https://doi.org/10.1093/ptj/81.5.1110
Allison SC, Abraham LD. Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy. Inter J Rehab Res 2001;24:15-24. DOI: https://doi.org/10.1097/00004356-200103000-00003
Morris C. Orthotic management of children with cerebral palsy. J Prosthet Orthot 2002;4:150-8. DOI: https://doi.org/10.1097/00008526-200212000-00005
Leung J, Moseley A. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia: systemic literature review. Physiother 2003;89:39-55. DOI: https://doi.org/10.1016/S0031-9406(05)60668-2
