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Ter, 24 de Novembro de 2009 13:57
Escrito por Paulo Roberto Silveira

O QUE É A NEUROLOGIA

 

As doenças nervosas, estudadas desde os tempos de Hipócrates, só foram descritas com rigor nas últimas décadas do século  XIX. Duas escolas se destacaram nos primórdios da especialidade: a Francesa, de Jean-Martin Charcot, titular da primeira cátedra de doenças nervosas criada na Universidade de Sorbone, em Paris, em 1882. Alinharam-se com os conceitos dessa escola Jules Déjerine, estudioso de diversas  síndromes neurológicas, e os irmãos Pierre-Marie e Joseph Babinki,  que deram importantes contribuições ao estudo das doenças do cérebro e da medula espinhal. A outra grande escola neurológica cuja influência perduraria por décadas, foi a escola   Britânica. Se a Francesa caracterizou-se pelo caráter  revolucionário de sua orientação,a escola Britânica teve como traço principal a extrema minúcia de seus estudos. Alguns dos ilustres neurologistas que dela fizeram parte foram Sherrington,Charles Bell, John Hughlings Jackson e Henry Head.

Mais tarde, a neurologia diferenciou-se em  outras  disciplinas subordinadas, a partir do trabalho de pesquisadores como Golgi, Ramón y Cajal, Walter Edward Dandy e Antonio Egas Moniz.

Do progresso da pesquisa científica  no domínio da neurologia resultou sua divisão em quatro subespecialidades; 1) a neuropediatria, á qual, dadas as características especiais do desenvolvimento nervoso infantil, corresponde uma parte muito delicada da medicina, a do estudo da formação e das primeiras fases do desenvolvimento neuronal; 2 ) a neurologia clinica propriamente dita, que se ocupa da  anatomia,  fisiologia e da patologia do sistema  nervoso; 3) a neurocirurgia, conjunto de técnicas cirúrgicas destinada á a reparação de lesões do sistema nervoso, e que, em determinados aspectos, quando útil para o tratamento de alterações mentais que se vincula á neuropsiquiatria.4) a neurologia forenses, constituída por equipe de peritos médicos neurologistas do Instituto Medico Legal Afrânio Peixoto do Rio de Janeiro, que realiza exame subsidiário neurológico e ou subsidia pareceres técnico na especialidade objetivando a confecção dos seguintes documentos médico-legais, sempre mediante solicitação de perito legista do Instituto Médico Legal, ou de Autoridade policial ou judiciária :

a)         Auto de exame de corpo de delito

b)         Laudo Indireto

c)         Parecer médico-legal

 

Os peritos neurologistas louvam-se  no Auto de Exame de Corpo de Delito ou  no Laudo Indireto original para a realização do exame subsidiário neurológico e a confecção dos seus laudos. Portanto, tem de ter acesso ao AECD ou LI confeccionados pelos Peritos solicitante ( mesmo não finalizado). Isto obriga  aos  Peritos de outros postos do IMLAP o envio de cópias carbonadas, xerox ou duplicatas dos mesmos.O exame subsidiário neurológico é suscitado apenas para esclarecer e complementar as dúvidas  na especialidade dos Peritos Legistas solicitantes e ou da Autoridade (Delegado, Juiz,Promotor), requisitante. Não existe como documento Médico-Legal primitivo. O exame Neurológico Forense é uma contribuição subsidiária para auxiliar  na confecção do AECD mais especificamente na resposta ao 6º quesito – Se a lesão resultou debilidade permanente ou perda ou inutilizarão de membro, sentido e função e o 7º quesito – Se a lesão resultou incapacidade permanente  para o trabalho ou enfermidade incurável ou deformidade permanente, que qualificam  a lesão  funcional, e da  gravidade da lesão. O exame Neurológico Forense é técnico – pericial , restringindo-se aos aspectos objetivos da semiologia neurológica: observando sempre a máxima do visum et  repertum  .

As alterações da mentação ( mentais)  e do comportamento não á esfera de atinência da Neurologia Forense, e devem ser avaliadas pelo Setor de Psiquiatria Forense do IMLAP. As alterações osteo-articulares puras não são em si subsidiáveis pelo exame Neurológico. As queixas sensitivas do periciado (táteis, térmicas, dolorosas, visuais, auditivas, olfativas, gustativas, etc), dado o seu caráter subjetivo, não são subsidiáveis pelo exame Neurológico. Sobre  as alterações auditivas e visuais, melhor dirão respectivamente os exames  subsidiários Otorrinolaringológicos e Oftalmológicos realizados neste IMLAP. As queixas dismnésicas isoladas do periciado (dificuldade ou  déficit de memória ) não são subsidiáveis pelo exame Neurológico. Caso o periciado apresente-se  ao exame com imobilização  ( ortopédica, por exemplo) de segmento corporal que necessite ser examinado diretamente o exame subsidiário Neurológico será ultimado apenas  após a retirada da imobilização. Os exames solicitados pelos IMLAP fora da SEDE qualquer que seja, deverão ser datilografados, e protocolados no documento próprio de entrega de exames subsidiários do setor.

A Neurologia é o ramo da medicina que estuda as doenças e tratamentos das afecções do sistema nervoso central, periférico e autônomo. Não existem, contudo, limite nítido entre a neurologia e algumas outras especialidades, pois o organismo funciona como um todo integrado, e alterações de um determinado sistema podem afetar outro. Assim, ao lado de afecções puramente neurológicas, existem outras em que o comprometimento do sistema nervoso é secundário ao de estruturas não neurológicas.

A Neurologia tem por objeto a patologia da vida de relação instrumental, Isto é, das vias  e dos centros psicomotores que constituem  subsistemas funcionais. Os problemas estruturais neurológicos ou neuropatológicos competem a Neurologia.

 

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O(A) escritor(a) Paulo Roberto Silveira escreve para o Canto do Escritor desde Seg, 26 de Outubro de 2009.

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