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Paralytic rabies: a clinico-pathological study

J S Chopra, A K Banerjee, J M Murthy

    Brain : a Journal of Neurology
    |December 1, 1980
    PubMed
    Summary
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    Paralytic rabies primarily affects peripheral nerves, causing demyelination and axonal loss. Spinal cord and brain pathology result from direct virus infection, leading to severe motor and respiratory muscle weakness.

    Area of Science:

    • Neurology
    • Virology
    • Pathology

    Background:

    • Rabies is a fatal viral zoonosis transmitted primarily through animal bites.
    • Paralytic rabies, a less common form, presents with neurological deficits mimicking other conditions.
    • Understanding the neuropathology is crucial for diagnosis and management.

    Purpose of the Study:

    • To describe the clinical and pathological features of paralytic rabies.
    • To investigate the specific changes in peripheral nerves and central nervous system.
    • To elucidate the potential mechanisms of nerve damage in rabies.

    Main Methods:

    • Retrospective analysis of 11 paralytic rabies cases.
    • Detailed clinical data collection, including incubation period and symptoms.

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  • Histopathological examination of peripheral nerves, spinal cord, and brain, focusing on demyelination, axonal loss, and inclusion bodies.

    • Main Results:

    • Mean incubation period was 49 days; mean survival post-symptom onset was 8.4 days.
    • Presenting symptoms included pain, paresthesiae at the bite site, progressing to paralysis, motor weakness, and respiratory muscle involvement.
    • Histopathology revealed inflammatory reactions, vascular changes, and inclusion bodies in the CNS. Peripheral nerves showed segmental demyelination, remyelination, and Wallerian degeneration, with demyelination often being the primary lesion.

    Conclusions:

    • Paralytic rabies involves significant peripheral nerve damage, potentially due to cross-antigenic action on myelin.
    • Central nervous system pathology is attributed to direct viral infection.
    • The findings highlight the complex neuropathogenesis of rabies, affecting both peripheral and central nervous systems.