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.

More general terms

• peripheral nerve disease; peripheral neuropathy