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

Marleide Da Mota Gomes,Marcos Raimundo Gomes De Freitas

doi:10.1590/0004-282x-anp-2020-0479

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.

Highlights

The Paraguayan War ended 150 years ago
The locked-in syndrome (LIS), known as motor deafferentation syndrome, is a rare neurological disorder that was first described by Plum and Posner[1] in 1966, and which is characterized by quadriplegia and anarthria with preserved consciousness
Taunay was a writer, musician, teacher, military engineer, politician, historian and Brazilian sociologist. He reports the case of a Brazilian soldier who presented an ascending paralysis, mental confusion, followed by an apparent lucidity associated with quadriplegia (Box 1)

Summary

Introduction

The Paraguayan War ended 150 years ago. Back 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. He reports the case of a Brazilian soldier who presented an ascending paralysis, mental confusion, followed by an apparent lucidity associated with quadriplegia (Box 1). This syndrome is linked to several etiologies; it can stem from basilar artery occlusion by stroke, Gayet-Wernicke encephalopathy (GWE) with central pontine myelinolysis (CPM) due to thiamine deficiency, a form of dry beriberi, and the Guillain-Barré syndrome (GBS).

Results

Conclusion