AbstractHere, we describe a case of acute disseminated encephalomyelitis (ADEM) that occurred during a plausible risk interval following inactivated influenza vaccination in a previously healthy 27-year-old man from Manaus, Brazil. He was treated with intravenous methylprednisolone and immunoglobulin. One-month follow-up revealed resolution of the brain lesions, but not of the spinal cord lesions. No recurrence or progression of the main neurological symptoms was observed. After two years of monitoring, the patient continues to experience weak lower limbs and urinary retention. Thus, we recommend that ADEM should be considered in a patient presenting with neurological symptoms after influenza vaccination.

Determinaram valores de referência para limiares de percepção de corrente elétrica senoidal em indivíduos normais, utilizando-se o instrumento Neurometer®; contrastaram-se os resultados com os fornecidos pelo fabricante; analisaram-se os limiares em diferentes segmentos corporais e avaliou-se o efeito da idade, sexo, grau de escolaridade e reutilização dos eletrodos. Estudou-se uma amostra de 101 voluntários normais (68 mulheres), com idades entre 17 e 87 anos. O procedimento foi completamente automatizado utilizando o método de límites e o de escolha forçada. Houve diferença significante entre os limiares obtidos no dedo indicador e no hálux nas três freqüências. Não houve diferenças significantes em relação ao sexo e grau de escolaridade; a idade apresentou discreta relação em algumas medidas. A reutilização dos eletrodos por três vezes nos dedos indicadores não comprometeu a confiabilidade, porém no hálux direito a reutilização por mais de duas vezes comprometeu a determinação do limiar para 2000Hz. Os valores obtidos diferiram das referências fornecidas pelo fabricante, nas freqüências 250Hz e 5Hz.

Reference values using the instrument Neurometer® were determined and compared with those suggested by the manufacturer; the sensory thresholds for the different frequencies in different body segments were determined; the influence of age, level of education, gender and the reutilization of the electrodes in the different sites were also evaluated. Sensory threshold was determined in 101 normal volunteers (68 women), ages ranged from 17 to 87 years old. The procedure was fully automated with the sensory threshold being determined by the method of limits followed by the forced choice method. Analysis of the results revealed that: there was a significant difference between the values obtained for the index fingers and the halux; no difference was detected between both index fingers; gender and level of instruction had no effect on the results, age had a small influence after stimulation with 2000Hz and 250Hz; three reutilizations of the electrodes did not affect the results on the index fingers, however at the halux, the third utilization deteriorated the results from the 2000Hz stimulation. Except for the 2000Hz stimulation, significant differences were suggested between the values reported here and those provided by the manufacturer.

Descreve-se um caso de síndrome de Miller Fisher associada a neuropatia óptica desmielinizante bilateral, confirmada pelo exame de potencial evocado visual, sugerindo possível comprometimento do sistema nervoso central nessa síndrome.

We report a case of Miller Fisher syndrome and bilateral demyelinating optic neuropathy suggesting the possible involvement of central nervous system in this syndrome. The optic neuritis was confirmed by visual evoked potential.