Abstract Introduction: The study of personality trait and type of physicians began in the United States in 1960 under the hypothesis that personality prompts the type of specialty chosen to be pursued. Chile and Spain are the countries where this relationship has been studied most. In Mexico there are few studies that have served to further understand the ways in which physicians confront problems they face during their training. This is the first study done with physicians that are part of the different medical specialties imparted in the Luis Guillermo Ibarra Ibarra National Institute for Rehabilitation under the hypothesis that there is a relationship between the type of personality and the medical specialty chosen. Objective: To determine if the National Institute for Rehabilitation resident physician's personality type differs significantly from other specialities. Method: A cross-sectional study was performed in which the 16PF-5 factorial personality questionnaire was completed by 50 resident physicians belonging to five of the seven specialities available in the Luis Guillermo Ibarra Ibarra National Institute for Rehabilitation. The questionnaire examines 16 primary personality traits that include 5 general personality dimensions. The data obtained was analysed using the SPSS 17 statistics program. For the comparison between two proportions, the chi squared test was used, and the distribution form of the factorial personality questionnaire scores was corroborated with the Kolmogorov-Smirnov test. The mean comparison by sex was performed using the Student t test for independent samples or with the Mann Whitney U test. The mean comparison for specialties was made using analysis of variance or with Kruskal-Wallis. The multivariate analysis was performed using a discriminant analysis model and the 2 factor analysis of variance. Results: Of the 16 traits, reasoning, tension, and self-sufficiency stand out. The lowest were: affability and vigilance. Of the 5 dimensions, independence and anxiety stand out, while the lowest were extroversion and hardness. By gender, they were differentiated M vs. F: stability 6.20 ± 1.3 vs. 5.17 ± 1.5 (p = .018) and (0.655, p = .0001). Conclusions: There are outstanding differences among the personality traits and personality dimensions.

Resumen Introducción: El estudio de los rasgos y tipos de personalidad de los médicos se inició en los Estados Unidos en 1960 bajo la hipótesis de que la personalidad induce la elección del tipo de especialidad médica que se decide realizar. En Chile y España es donde más se ha estudiado esta relación. En México hay pocos estudios que han servido para comprender las formas en las que afrontan los problemas que se presentan durante su formación. Este es el primer estudio que se realiza con los médicos residentes de las diferentes especialidades que se imparten en el Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra con la hipótesis de que existe relación entre los tipos de personalidad con la especialidad elegida. Objetivo: Determinas si los tipos de personalidad de los médicos residentes del Instituto Nacional de Rehabilitación difieren significativamente entre las distintas especialidades. Método: Se realizó un estudio transversal aplicando el cuestionario factorial de la personalidad 16PF-5 a 50 médicos residentes de cinco de las siete especialidades que se cursan en el Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra. El cuestionario explora 16 rasgos primarios con los cuales se integran 5 dimensiones generales de personalidad. Los datos obtenidos se analizaron con SPSS 17. Para la comparación de dos proporciones se aplicó chi cuadrado, la forma de la distribución de las puntuaciones del cuestionario factorial de personalidad se corroboraron con el estadístico Kolmogorov Smirnov. Las comparaciones de medias por sexo se efectuaron con t de Student para muestras independientes o en su caso con U de Mann Whitney. Las comparaciones de medias por especialidad se hicieron con el análisis de varianza o con Kruskal- Wallis, los análisis multivariados se realizaron con el modelo de análisis discriminante y análisis de varianza de dos factores. Resultados: De los 16 rasgos destacan: razonamiento, tensión y autosuficiencia; más bajas: afabilidad y vigilancia; de las 5 dimensiones sobresalieron independencia y ansiedad y más bajas extraversión y dureza. Por género se diferenciaron M vs. F: estabilidad 6.20 ± 1.3 vs.5.17 ± 1.5 (p = 0.018) y atrevimiento 6.45 ± 1.4 vs.4.70 ± 1.4 (p = 0.0001). Conclusiones: Existen diferencias sobresalientes entre los rasgos y dimensiones de la personalidad.

The morphogenic development of gametophyte Cheilanthes bonariensis is described from spores collected in the municipality of Tlaxco, Tlaxcala, Mexico. Its were sown in polyurethane vessel of 262 ml in two natural substrates (maquique and plant litter). This taxon has trilete spores with spherical or oval shape. The germination Vittaria type was observed at 15 days in both substrates. The gametophyte development was Adiantum type, the young gametophyte was presented to 31 days in plant litter and 54 in maquique. The adult gametophytes were observed at 44 days in plant litter and 54 days in maquique; the gametangia were not appreciated. The sporophytes were established through an apogamic bud from 54 days in plant litter and maquique at 93 days. In the day148, the sporophytes were formed from olds prothalli necrotic. The development of the sporophyte in maquique was slow, in plant litter was quick. Based on the time of development of the sporophytes of this species it may be susceptible to a possible commercial exploitation.

Se describe la morfogénesis de los gametófitos de Cheilanthes bonariensis a partir de esporas recolectadas en el municipio de Tlaxco, Tlaxcala, México. La siembra se realizó en vasos de unisel de 262 ml en dos sustratos naturales (maquique y tierra de hoja). Las esporas son triletes de forma esférica u ovalada. La germinación de tipo Vittaria se observó desde los 15 días en ambos sustratos. El desarrollo del prótalo corresponde al tipo Adiantum, el gametófito joven se presentó a los 31 días en tierra de hoja y a los 54 en maquique. Los gametófitos adultos se observaron desde los 44 días en tierra de hoja y 54 en maquique; no se apreció la formación de gametangios. Los esporófitos se desarrollaron a través de una yema apogámica a partir de los 54 días en tierra de hoja y a los 93 en maquique. A los 148 días los esporófitos se formaron a partir de prótalos viejos necrosados. El desarrollo del esporófito en maquique fue lento en relación al crecimiento en tierra de hoja y con base en los tiempos de desarrollo de los esporófitos de esta especie se sugiere que puede ser susceptible para una posible explotación comercial.

We describe the life cycle of Pellaea ternifolia (Cav.) Link subsp. ternifolia. Studied material was collected in a disturbed forest of Pinus in San Miguel de los Alcanfores, Tlaxco municipality, State of Tlaxcala, Mexico. Spores were sown in polyurethane vessel of 262 ml prepared in the following manner: the glasses were layered with ceramic, river stone, mosquito net and three natural substrates (plant litter, maquique and moss), all previously sterilized and enclosed in plastic bags tied with copper wire. The cycle proved to be typically isosporeus with prothallial development corresponding to the Adiantum type. The gametophytes were cordate, 70% of them produced antheridia and archegonia and the other 30% were apogamic. Young sporophytes were obtained around 63 days after sowing.

Se describe el ciclo de vida de Pellaea ternifolia (Cav.) Link subsp. ternifolia. Los especímenes fueron recolectados en un bosque de Pinus perturbado en San Miguel de los Alcanfores, municipio de Tlaxco, Tlaxcala, México. Las esporas fueron sembradas en vasos de unicel de 262 ml con cerámica (barro molido), piedra de río, tela de mosquitero y tres soportes de cultivo (tierra, maquique y musgo), todo previamente esterilizado y cerrado con plástico y alambre de cobre. El ciclo fue isospórico con desarrollo del protalo tipo Adiantum. En la fase cordada se apreciaron gametófitos con anteridios y arquegonio en una proporción cercana al 70% y el otro 30% fueron gametófitos apogámicos. Los esporófitos jóvenes se obtuvieron a partir de los 63 días.

The present work investigated the penetration pathways of Fasciola hepática (Linnaeus, 1758) into the hepatopancreas of Lymnaea truncatula (Muller, 1774) and Lymnaea cubensis (Pfeiffer, 1839), two mollusks obtained from Fasciolosis endemic areas in Russia and Mexico, respectively. The larval trajectory showed dissolution of intercellular substance and deformation of epithelial cells of mollusk's tissues. Cytological changes in the ductal epithelium of the digestive gland and in the connective tissue of hepatopancreas were found. Some differences in the penetration and damage pathways in the two species of mollusks studied were observed; thus highlighting the differences in the environmental conditions prevailing in each geographic area.

En el presente trabajo se estudiaron las vías de penetración del miracidio de Fasciola hepática (Linnaeus, 1758) dentro del hepatopáncreas de Lymnaea truncatula (Müller, 1774) y Lymnaea cubensis (Pfeiffer, 1839), en 2 moluscos obtenidos de las zonas endémicas de Fasciolosis de Rusia y de la República Mexicana respectivamente¹. El trayecto de la larva mostró la disolución de la sustancia intercelular y deformación de células epiteliales de los tejidos de los moluscos. A nivel citológico se observaron cambios en el epitelio lineal de cobertura de los ductos de la glándula digestiva y en el tejido conjuntivo del hepatopáncreas. Se observaron diferencias en las vías de penetración y afectación en las dos especies de moluscos estudiados, marcando así las diferencias de las condiciones ecológicas que prevalecen en cada zona geográfica.

CONTEXTO E OBJETIVO: O sinal de Lhermitte, um sinal neurológico clássico, é uma rara manifestação clínica da deficiência de vitamina B12. O objetivo foi relatar o caso de um paciente idoso com deficiência de vitamina B12, cuja manifestação clínica inicial foi a presença do sinal de Lhermitte. RELATO DO CASO: Paciente idoso com deficiência de vitamina B12, apresentou-se com disfunção cognitiva, polineuropatia periférica e ataxia sensitiva, cuja manifestação clínica inicial foi a presença do sinal de Lhermitte. Este sinal é uma das mais raras manifestações da deficiência de vitamina B12.

CONTEXT AND OBJECTIVE: Lhermitte's sign, a classical neurological sign, is a rare manifestation of vitamin B12 deficiency. The aim here was to report on a case of an elderly patient with vitamin B12 deficiency whose first clinical manifestation was the presence of Lhermitte's sign. CASE REPORT: We describe an elderly patient with vitamin B12 deficiency who presented cognitive dysfunction, peripheral polyneuropathy and sensory ataxia, and whose first clinical manifestation was the presence of Lhermitte's sign. This sign is one of the rarest manifestations of vitamin B12 deficiency.

INTRODUÇÃO: Desordens do sono apresentando movimentos involuntários podem ser bastante perturbadoras aos pacientes, além de sua influência negativa no sono. OBJETIVO: Descrever o uso da toxina botulínica tipo-A (BoNT-A) no manejo do caso de um paciente cujo sono estava gravemente fragmentado por episódios de distonia do membro inferior direito, desencadeados por movimentos periódicos do sono (MPS). MÉTODO: Uma paciente com 79 anos portadora de hemiparesia direita leve seqüelar a isquemia cerebral (AVCI) procurou-nos por episódios dolorosos recorrentes de distonia noturna de seu membro inferior direito, os quais fragmentavam seu sono. Os episódios de distonia também podiam ser desencadeados voluntariamente, por extensão do hálux direito. Uma polisonografia confirmou que os episódios distônicos eram desencadeados pelos MPS. Vinte unidades de BoNT-A (20 U/frasco de 500 U) foram injetadas no seu extensor longo do hálux. RESULTADOS: Alguns dias após a injeção de BoNT-A os sintomas distônicos regrediram, e o sono da paciente tornou-se eficiente. CONCLUSÃO: As extensões involuntárias do hálux relacionadas aos movimentos periódicos do sono estavam provavelmente desencadeando os paroxismos distônicos noturnos pós-AVCI. A injeção de BoNT-A no extensor longo do hálux foi eficaz no manejo desta condição, resolvedo assim a fragmentação do sono.

INTRODUCTION: Sleep disorders presenting involuntary movements may be very annoying to patients, apart from their negative influence on sleep. OBJECTIVE: To report the use of botulinum type-A toxin (BoNT-A) to manage the case of a patient whose sleep was severely disrupted by episodes of dystonic posturing of the right lower limb triggered by periodic limb movements of sleep (PLMS). METHOD: A 79-year-old woman with mild post-stroke right hemiparesis presented with recurrent painful episodes of dystonia of the right lower limb, which disrupted her sleep. The dystonic episodes could also be voluntarily triggered by extension of the right hallux. Polysomnography confirmed that the dystonic episodes were triggered by PLMS. Twenty units of BoNT-A (20U/500U vial) were injected into her right extensor hallucis longus. RESULTS: Shortly after BoNT-A was injected, the dystonic symptoms abated, and the patient achieved better sleep efficiency. CONCLUSION: The PLMS-related involuntary extension of the hallux was probably triggering the nocturnal post-stroke lower limb dystonic paroxysms. BoNT-A injection into the right extensor hallucis longus was effective in managing this condition and thus resolved the associated disruption of sleep.

Quinfamide is an intraluminal amebicidal with high therapeutic efficacy and low toxicity. Its mechanism of action consists in the intraluminally immobilization of the Entamoeba histolytica trophozoite, and gets its maximum concentration blood level in about 7 hours. The objective of this paper is to evaluate the therapeutic action of quinfamide with a single dose in patients having sub-acute or chronic intestinal amebiasis parasitologicaly demonstrated, and to probe its security. Adults with a coproparasitoscopic exam mean concentration-flotation, as well as a complete clinical study were sudied. The cases that result positive because of the identification of parasite forms of E. histolytica and that fulfill the inclusion requirements besides signing the consent letter were given a single 300 mg dose of quinfamide and were kept in the following days under strict observation with coproparasitoscopic control studies realized the next five, six, seven, fourteen and twenty one days. From 568 persons studied, 221 (38.9%) were positive to the presence of intestinal E. histolytica. The coproparasitoscopic control studies showed that in 35 persons (15.84%), the parasite forms continued to be in the feces; and 186 persons (84.16%) corresponded to negativized cases. The clinical follow up never revealed the presence of secondary effects with the administration of this drug. In conclusion, the therapeutic efficacy of a single dose of quinfamide in the treatment of E. histolytica infection was good in comparison with the quinfamide administration of the same dose but in three intakes a day

La quinfamida es un amebicida intraluminal, con alta eficacia terapéutica y baja toxicidad. Su mecanismo de acción consiste en la inmovi-lización intraluminal del trofozoito de Entamoeba histolytica y alcanza sus niveles máximos de concentración sanguínea en aproximadamente 7 horas. El objetivo de este trabajo fue evaluar la acción terapéutica de la quinfamida con una dosis única en pacientes con amibiasis intestinal sub-aguda o crónica demostrada parasitoló-gicamente; además de comprobar su seguridad. Se estudiaron a 568 personas a quienes se practicaron exámenes coproparasitoscópicos por concentración-flotación, además de un estudio clínico completo. A los individuos que resultaron positivos por la identificación de formas parasitarias de E. histolytica y llenaron los requisitos para su inclusión en el estudio, además de haber proporcionado su consentimiento por escrito, se les administró una dosis única de 300 mg de quinfamida y se hizo un riguroso seguimiento con exámenes coproparasitoscópicos de control durante los 5, 6, 7, 14 y 21 días postratamiento. De las 568 personas estudiadas, 221 (38,9%) fueron positivos a la presencia de E. histolytica en el intestino. Los exámenes coproparasitoscópicos de control demostraron que 35 personas (15,84%), continuaban excretando al parásito en las heces mientras que 186 (84,16%), se negativizaron. El seguimiento clínico demostró la ausencia de efectos secundarios a la administración del fármaco. Se concluye que la eficacia terapéutica de la quinfamida en dosis única en el tratamiento de la infección por E. histolytica fue buena en comparación con la administrada durante 3 días a la misma dosis

Xantomatose cerebrotendínea é doença autossômica recessiva tratável causada pelo acúmulo de lipídeos por deficiência da enzima 27-esterol hidroxilase na produção de ácido cólico e deoxicólico. Descrevemos dois irmãos brasileiros com dificuldade cognitiva e diarréia crônica. Um deles apresentava catarata bilateral. Os achados neurológicos foram dificuldade progressiva para deambular, ataxia de membros e sinais piramidais. Ambos tinham xantomas de tendão aquileu bilateralmente. O exame de ressonância magnética revelou áreas de sinal hiperintenso em ambos os hemisférios cerebelares. Descrevemos os casos com diagnóstico genético comparando-os com a literatura. O estudo do gene CYP27A1 demonstrou a mutação C1183T no exon 6.

Cerebrotendinous xanthomatosis is a treatable rare autossomal recessive disease characterized by lipid storage secondary to a sterol 27-hydroxylase deficiency in the formation of cholic and chenodeoxycholic acids. We describe two Brazilian brothers with cognitive impairement and chronic diarrhea. One of them also presents bilateral cataracts. Neurological findings were progressive walking deficit, limb ataxia and pyramidal signs. Both patients had bilateral Achilles tendon xanthomata. Magnetic resonance image showed signal alterations in cerebellar hemispheres. We describe these cases with molecular genetic analysis confirming diagnosis and comparing with previous literature. The CYP27A1 gene study showed a C1187T mutation on exon 6.

Dez por cento de todos os eventos vasculares encefálicos são devido às hemorragias intracerebrais espontâneas, associados a drogas (lícitas e ilícitas) em 9,5% de todos os casos em adultos jovens. Relatamos o caso de um homem de 44 anos de idade, sem doenças prévias, que apresentou cefaléia súbita e hipertensão arterial 24 horas após o uso de congestionante nasal contendo nafazolina. A tomografia de crânio evidenciou hemorragia talâmica. Durante a investigação não foram encontrados outros fatores de risco e a hemorragia foi atribuída à exposição à nafazolina.

Ten percent of all strokes are due to spontaneous cerebral hemorrhages. They are associated to drugs (licit and illicit) in 9.5% of all cases in young adults. This is a case report of a 44-year-old man, without previous morbidities, who presented a sudden onset headache and arterial hypertension 24 hours after use of naphazoline as nasal decongestant. Cranial tomography showed right thalamus hemorrhage. Cerebral angiography showed no aneurisms, vascular malformations or vasculitis. No other risk factors were found during investigation in this patient and the stroke was attributed to naphazoline exposition.

A case of myiasis in a 70 years-old man with antecedents to habit alone with bad hygienic and deficient feeding. Because a vascular cerebral disease, he has right facial paralysis and also in contralateral superior and inferior extremities. His suffering starts with a macule that evolutes to ulcer in the dorsal region of the left foot. The appearance of worms is observed. These worms were identified as Dermatobia hominis larvae. Treatment consisted in larvae elimination by desbridation and antibioticotherapy. Because of the regional necrosis grade, supracondylean amputation of the left foot was required. Patient evolutes satisfactorily and he is controlled through the external consult service.Myiasis due to larva of Dermatobia hominis is very frequent in Mexico and Latin America. Even it is a very mild parasitoses, it could present very serious complications when is associated with other pathologies.

RESUMEN Se presenta un caso de miasis en un paciente masculino de 70 años de edad, cuyos antecedentes son: el habitar solo en malas condiciones de higiene y alimentación. A causa de una enfermedad vascular cerebral, presenta parálisis facial derecha y en las extremidades superior e inferior contralaterales. Inicia su padecimiento con una mácula eritematosa que evoluciona a úlcera en la región dorsal del pie izquierdo. A partir de esta úlcera se observa la salida de gusanos, que posteriormente se clasificaron como larvas de Dermatobia hominis. El tratamiento consistió en la eliminación de las larvas por desbridamiento y administración de antibióticos. Debido al grado de necrosis regional, se requirió la amputación supracondílea del pie izquierdo. El paciente evoluciona satisfactoriamente y es controlado a través de la consulta externa. Las miasis por larvas de D. hominis son muy frecuentes en México y América Latina. Aún cuando constituyen una parasitosis benigna, pueden presentar serias complicaciones al asociarse a otras patologías

O teste do amital sódico intracarotídeo (TASI ou teste de Wada) é procedimento comum na avaliação de pacientes portadores de epilepsia clinicamente refratária candidatos a cirurgia de epilepsia. Tem por objetivo promover interrupção seletiva e temporária da função hemisferial, definindo lateralização de linguagem e risco de comprometimento de memória no pós-operatório. São esperadas mudanças comportamentais durante o teste, as quais podem durar vários minutos, porém, em geral, são sutis e facilmente manejáveis. Relatamos uma série de casos em que ocorreram comportamentos pouco usuais, bizarros, incluindo agitação e agressividade. Estes comportamentos comprometem o teste (paciente deve ser contido), podendo levar a atrasos ou mesmo abortamento do mesmo, além de produzir dados menos confiáveis. Os casos foram revisados, visando a definição de preditores de sua ocorrência. Estas reações são raras (5% dos casos). Efeito barbitúrico, perfil psiquiátrico, dominância cerebral e seletividade da injeção não puderam ser validados como preditores. Explicações detalhadas, repetição e simulações podem ser utéis na prevenção deste tipo de ocorrência.

The intracarotid sodium amytal test (ISAT or Wada Test) is a commonly performed procedure in the evaluation of patients with clinically refractory epilepsy candidates to epilepsy surgery. Its goal is to promote selective and temporary interruption of hemispheric functioning, seeking to define language lateralization and risk for memory compromise following surgery. Behavioral modification is expected during the procedure. Even though it may last several minutes, in most cases it is subtle and easily manageable. We report a series of patients in whom those reactions were unusually bizarre, including agitation and aggression. Apart of the obvious technical difficulties (patients required physical restraining) those behaviors potentially promote testing delay or abortion and more importantly, inaccurate data. We reviewed those cases, seeking for features that might have predicted their occurrence. Overall, reactions are rare, seen in less than 5% of the ISAT procedures. The barbiturate effect, patients' psychiatric profiles, hemisphere dominance or selectiveness of the injection were not validated as predictors. Thorough explanation, repetition and simulation may be of help in lessening the risk of those reactions.

O tremor essencial (TE) é o distúrbio do movimento mais frequente. Entre os tratamentos de primeira escolha está o uso de beta-bloqueadores. O objetivo deste trabalho é relatar os resultados do uso de propranolol de ação prolongada (PAP) em 40 pacientes com TE e virgens de tratamentos anteriores. MÉTODO: 40 pacientes com TE foram submetidos a um protocolo de avaliação pré-estabelecido em que constavam escalas de classificação para o tremor e escalas de avaliação da severidade do tremor. Todos os pacientes foram submetidos a avaliação inicial e após 1 mês de tratamento. RESULTADOS: com relação ao tipo de tremor, 36 pacientes (90% do total) tinham o tipo 2; os tipos 3 e 4 ocorreram em dois pacientes cada (10% do total). Houve história familiar de tremor em 25 casos (62,5%). A média de idade dos pacientes foi 43,1 anos e a média de idade de início dos sintomas foi 27,4 anos. Dos 40 indivíduos avaliados, 33 ou 82,5% apresentaram algum grau de melhora com PAP; em 52,5 % a melhora foi considerada ótima ou boa. CONCLUSÃO: o PAP mostrou ser uma medicação adequada para o tratamento do TE nesta amostra de 40 pacientes avaliados.

Essential tremor (ET) is the most common movement disorder and betablockers are still consideres the first line of treatment. The aim of our study is to report the clinical response to long action propranolol (LAP) of 40 patients diagnosed with essential tremor with no previous treatment. METHOD: 40 patients with ET were evaluated with rating scales for severity of tremor and clinical classification of ET. All patients were evaluated at least twice, at enlrollment and one month after starting treatment. RESULTS: thirty-six patients (90%) had type 2 ET and types 3 and 4 ocurred in two patients each (10%). Familiar history was positive in 25 patients (62.5%). Mean age at first evaluation was 43.1 years and mean age at onset was 27.4 years. Of all patients, 33 (82.5%) had some degree of benefit and in 52,5 % this benefit was either good or excelent. CONCLUSION: LAP seems to be a good treatment option for ET in our series of 40 patients.

Relatamos o caso de uma mulher de 30 anos com quadro de fraqueza muscular nos membros inferiores com predomínio distal com início há 7 anos. Na evolução apresentou fraqueza muscular nos membros superiores. O exame físico mostrava nervos cranianos sem alterações, hipotrofia bilateral de quadriceps e interósseos dos pés, redução da força muscular mais intensa em tibiais anteriores e interósseos dorsais dos pés e reflexos tendinosos globalmente hipoativos. Foi realizado teste de estimulação repetitiva que mostrou decremento maior que 10% no nervo fibular e ulnar. A dosagem de anticorpos anti-receptor de acetilcolina foi positiva. Tomografia computadorizada de tórax foi normal. Dosagem de hormônios tireoidianos mostrou evidências laboratoriais de hipertireoidismo, porém sem manifestações clínicas. Foi iniciado tratamento com piridostigmina havendo melhora importante do quadro clínico. A fraqueza distal é um sintoma inicial raro na miastenia grave (MG). Contudo, a MG deve entrar no diagnóstico diferencial de doenças que cursam com fraqueza muscular distal de membros superiores ou inferiores.

We report the case of a 30-year-old woman with a 7-year history of distal lower limbs weakness that evolved to upper limbs weakness. On neurological examination, she presented normal cranial nerves, bilateral quadriceps and feet interosseous atrophy, normal muscular tonus, muscular weakness more severe in dorsal feet interosseous and anterior tibial, and decreased deep tendon reflexes. Repetitive nerve stimulation of the ulnar and fibular nerves showed a decrement greater than 10% of the compound muscle action potential. Antibody against acetylcholine receptor titer was positive. Computed tomography scan of the thorax was normal. Thyroid function tests showed evidence of hyperthyroidism. Distal muscular weakness is a rare onset presentation of myasthenia gravis. However, myasthenia gravis must be considered in the differential diagnosis of distal limb weakness.

A cerebelite aguda pode ocorrer em associação a infecção pelo vírus da varicela-zoster, enterovirus, caxumba, micoplasma e outros agentes infecciosos. A cerebelite aguda é uma complicação rara da infecção pelo vírus Epstein-Barr (EBV). Relatamos o caso de uma mulher de 21 anos com história de 12 dias de evolução com náuseas, vômitos, ataxia de marcha e membros, tremor cefálico e de membros, opsoclono, mioclonias e rash cutâneo. Sorologia para EBV foi positiva. A infecção pelo EBV, com complicações neurológicas, pode não se apresentar com os sinais e sintomas clássicos da mononucleose infeciosa.

Acute cerebellitis can occur in association with varicella-zoster virus, enterovirus, mumps, mycoplasma, and other infective organisms. Acute cerebellitis is a rare complication of Epstein-Barr virus (EBV) infection. We report the case of a 21-year-old woman with a 12-day history of nausea and vomiting, gait and limbs ataxia, myoclonus, tremor of head and all four limbs, opsoclonus and cutaneous rash. Anti-EBV IgG and IgM antibodies against antiviral capsid were positive and anti-EBV against virus-associated nuclear antigen was also positive. EBV infection in association with neurological findings can occur without the classic signs and symptoms of infectious mononucleosis.