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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(06): 554-556
DOI: 10.1590/0004-282X-ANP-2020-0479
Articles

Probable first report of a motor deafferentation syndrome in the Paraguayan War

Provável primeiro relato de uma síndrome de desaferentação motora na Guerra do Paraguai
Marleide da Mota GOMES 
1   Universidade Federal do Rio de Janeiro, Instituto de Neurologia, Rio de Janeiro RJ, Brazil.
2   Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Laboratório de História da Psiquiatria, Neurologia e Saúde Mental, Rio de Janeiro RJ, Brazil.
,
Marcos Raimundo Gomes de FREITAS 
3   Universidade Federal Fluminense, Rio de Janeiro RJ, Brazil.
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ABSTRACT

The Paraguayan War ended 150 years ago. Back then, there were outbreaks of combatants’ limb weakness and tingling related to "palustrian cachexia", not clearly funded at the time on nutritional deficiency, the use of native flora to feed troops, and alcoholism. We report a case of a soldier with ascending paralysis, mental confusion and finally tetraplegia with preserved oculomotricity. This would probably be a case of locked-in syndrome (LIS) due to Gayet-Wernicke's encephalopathy consequent to thiamine deficiency. The role of thiamine in the peripheral or central nervous system expression was shown decades later to be related to poor diet, or use of foods containing thiaminase or thiamine antagonists, worsened by the fact that the bodily stores of thiamine are restricted, and deficits may grow fast.

RESUMO

A Guerra do Paraguai terminou há 150 anos. Houve surtos de fraqueza dos membros dos combatentes e parestesias relacionadas à “caquexia palustre”, não claramente fundamentados na época sobre deficiência nutricional, o uso da flora nativa para alimentar as tropas e o alcoolismo. Referimo-nos a um caso de um militar com paralisia ascendente, confusão mental e finalmente tetraplegia com oculomotricidade preservada. Esse relato seria provavelmente devido a um caso de “síndrome do encarceramento” secundário à encefalopatia de Gayet-Wernicke consequente à deficiência de tiamina. O papel da tiamina na expressão periférica ou do SNC foi previsto décadas mais tarde em relação a uma dieta pobre, ou ao uso de alimentos contendo tiamina ou antagonistas da tiamina, agravado pelo fato de que as reservas corporais de tiamina são restritas, e os déficits podem se manifestar rapidamente.

Keywords:

Beriberi - Polyneuropathy - Brain Diseases - Myelinolysis, Central Pontine - Thiamine Deficiency - Locked-in Syndrome

Palavras-chave:

Beriberi - Polineuropatias - Encefalopatias - Mielinólise Central da Ponte - Deficiência de Tiamina - Síndrome do Encarceramento

Authors’ contributions:

MMG: collected references and worked on the first draft of the paper. MRGF: revised it critically for important intellectual content. The final approval of the version to be published was made by both authors.




Publication History

Received: 09 January 2020

Accepted: 30 November 2020

Article published online:
04 July 2023

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