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nutritional neuropathy
Etiology:
- risk factors
- bariatric surgery
- dietary modification
- gastrointestinal disturbance
- eating disorders
- most common deficiencies
- thiamine
- vitamin B6
- folate
* vitamin E, copper, & vitamin B12 levels were normal in most patients
Pathology:
- motor pathology predominantly axonal
- 35% able to ambulate independently after 22 months
- all patients with pure motor neuropathy & only 1 of 12 with sensory neuropathy able to ambulate independently after 22 months
Clinical manifestations:
- 58% present with a symmetric polyneuropathy with distal weakness, large-fiber & small-fiber sensory loss, & leg > arm hyporeflexia
- 35% present with a symmetric polyneuropathy
- 7% present with motor neuropathy
Laboratory:
- thiamine in serum
- vitamin B6 in serum
- folate in serum
- vitamin E in serum
- copper in serum
- vitamin B12 in serum
- CSF analysis: elevated protein in one patient
Complications:
- Wernicke encephalopathy (18%)
- optic atrophy (10%)
- myopathy (10%)
Management:
- 2/3 of patients require hospitalization
- 1 of 12 patients receiving IV immunoglobulin or glucocorticoid therapy for presumed immune-mediated neuropathy regained the ability to ambulate independently
- most patients require pain medications.
General
peripheral nerve disease; peripheral neuropathy
References
- Hamel JI, Logigian EL.
Clinical spectrum and prognosis in patients with acute nutritional axonal neuropathy.
Neurology 2023 Mar 27; [e-pub].
PMID: 36973043
https://n.neurology.org/content/early/2023/03/24/WNL.0000000000207215