The Charcot triad It is a medical criterion created in 1877 by French Dr. Jean-Martin Charcot. This doctor associated the appearance of three clinical manifestations for the presumptive diagnosis of two different clinical entities. The first is the cerebral triad, also known as (Charcot triad I) and the second corresponds to the biliary triad or (Charcot triad II).
The Charcot I or cerebral triad consists of three frequent signs in multiple sclerosis, these are: involuntary movements of the body (ataxia), involuntary movement of the eyes (nystagmus) or double vision (diplopia) and difficulty in emitting words in form continuous (scanned speech).
Multiple sclerosis is an autoimmune neurodegenerative disease of the central nervous system. It is characterized by demyelination of nerve fibers and axonal damage, due to an inflammatory reaction. This results in atrophy of the CNS, with a dysfunction in the transmission of nerve impulses..
Whereas, the clinical manifestations that comprise the Charcot II or biliary triad are: appearance of a yellow color in the skin and mucosa (jaundice), pain in the right upper quadrant, and febrile syndrome..
It should be noted that the manifestations of the biliary triad are not exclusive to the disease, but the combination of the three suggests the suffering of a clinical condition known as cholangitis or biliary sepsis..
Cholangitis is a disease characterized by an obstruction of the common bile duct, also known as common bile duct. It is caused by inflammation and infection of the hepatic and bile ducts or by the complication of cholelithiasis (stones in the gallbladder).
It is a true medical emergency that requires the administration of antibiotics and surgical intervention.
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Jean-Martín Charcot was a famous French doctor who brought a lot of knowledge to medicine, thanks to his tireless investigative spirit. Most of his research was developed in the field of neurology and psychiatry, although he also touched other branches of medicine.
At the age of 37 he began his work as a researcher, in the neurology area of the Hospital de la Salpêtrière. There he inaugurated a pathology laboratory where he would carry out all his research. He himself had microscopy and photography to study the lesions.
Charcot studied patients in life and also post mortem. With this, he was able to correlate the clinical manifestations of the patients in life and their respective pathological changes in the brain tissue. post mortem.
He described innumerable neurological diseases, among which is the now known multiple sclerosis, but at the time it was named by Charcot sclérose en plaques disséminées (plaque-spread sclerosis).
Today it is known that this disease affects not only the brain, but also the spinal cord. For its diagnosis, it proposed as a criterion what was called the Charcot triad I or the cerebral Charcot triad..
Likewise, he described the Charcot II triad or biliary Charcot triad, for the diagnosis of biliary disease, called by him as "liver fever", being today known as "cholangitis".
The Charcot I triad, as its name indicates, comprises three clinical manifestations, which are associated with multiple sclerosis. The Charcot triad I comprises:
Involuntary movements of the body. There is an incoordination of movements in general. The patient is not able to control this situation. These movements affect the patient's gait.
Difficulty articulating words. It is characterized by a difficult, torpid, interrupted and slow pronunciation. It is the product of atrophy of the central and peripheral nervous system.
The term nystagmus or nystagmus refers to involuntary movements of the eyeballs. These movements are usually highly variable in terms of frequency, direction and intensity. The movements can be circulatory, up and down, to both sides, oblique or a mixture of them.
Another frequent affectation is diplopia, which is an alteration of vision that is characterized by duplicating the images observed (double vision).
Dr. Charcot also proposed a combination of three symptoms to define a condition that he called liver fever and is now known as acute cholangitis. The Charcot II or biliary triad comprises:
This term is used when a yellowish pigmentation is observed on the skin or mucous membranes of affected people. It occurs due to an increase in bilirubin in the blood. In cholangitis, bilirubin accumulates due to biliary obstruction, preventing it from being eliminated. This manifestation only occurs in two thirds of patients with this pathology.
In cholangitis, pain may occur in the right upper quadrant of the abdomen, specifically in the right upper quadrant. The pain is recurrent, that is, it comes and goes with some frequency. The intensity of the pain can vary from episode to episode. Pain intensifies on palpation.
Pain in the right upper quadrant is an alert that guides where the problem originates. It is the second most frequent manifestation, it occurs in 70% of patients with cholangitis.
The febrile syndrome that occurs in cholangitis not only manifests as an intermittent rise in the patient's body temperature, but is also characterized by the presence of chills and excessive sweating (diaphoresis). Obviously it is a very nonspecific clinical manifestation on its own.
Fever is the most frequent manifestation, and it can be observed in approximately 90% of patients with this pathology. Two-thirds of patients with fever present with chills and 30% have hypotension, which manifests itself with excessive sweating.
The sensitivity of the Charcot I or cerebral triad is very low. Only 15% of patients with multiple sclerosis manifest the triad. Specificity is also low, since these signs can occur in other pathologies.
That is why, the guidelines that are currently accepted internationally for the diagnosis of multiple sclerosis are those proposed by McDonald.
These criteria were revised in 2017. In addition, there are also other resources that help in its diagnosis, such as the magnetic resonance study.
In this disease an early diagnosis is crucial, as this will help to place the appropriate treatment, delaying the progression of the disease.
For its part, the Charcot II triad is not exclusive for cholangitis, as it can also be observed in patients with cholecystitis and hepatitis. In this sense, although the Charcot II triad guides the diagnosis, it is also true that nowadays the diagnosis can be confirmed through a variety of studies..
The studies include laboratory tests (transaminases, alkaline phosphatase, white blood cell count, and bilirubin). As well as imaging studies, such as: ultrasound, computed tomography and magnetic resonance cholangioresonance.
On the other hand, it is important to emphasize that in 1959 the Reynolds pentad was proposed. Dr. Reynolds added two clinical manifestations to the Charcot II triad.
The added clinical manifestations were: presence of shock due to sepsis and depression of the central nervous system (mental confusion). Of course, Reynolds' pentad describes a much more serious condition, called "acute obstructive suppurative cholangitis.".
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