Subacute Sensory Ataxia and Optic Neuropathy with Thiamine Deficiency

Overview

Journal Nat Rev Neurol

Specialty Neurology

Date 2010 Mar 24

PMID 20308997

Citations 15

Authors

Marco Spinazzi

Corrado Angelini

Cesare Patrini

Affiliations

Soon will be listed here.

Abstract

Background: A 71 year-old man with a history of partial gastrectomy presented to the emergency department with subacute gait instability associated with painful dysesthesias and clumsiness in both hands. 10 years before presentation he had received a diagnosis of megaloblastic anemia, with no neurological involvement, as a result of vitamin B(12) and folate deficiency, for which he was receiving regular supplements.

Investigations: Neurological examination; routine laboratory testing; MRI of the spine and brain; lumbar puncture; electromyography; sensory, motor and visual evoked potentials, optic nerve optical coherence tomography; immunoelectrophoresis; cryoglobulins; immunological and infection tests; screening for onconeural antibodies; measurement of serum metabolic values, including vitamins B(12) and E, folates, homocysteine, copper, zinc and pyruvic acid; transketolase activity; gastrointestinal endoscopies; and the glucose breath test.

Diagnosis: Subacute sensory ataxia with bilateral optic neuropathy related to thiamine deficiency resulting from remote partial gastrectomy.

Management: Parenteral thiamine supplementation followed by chronic oral thiamine and short-term, low-dose multivitamins.

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References

Gill G, Bell D . Persisting nutritional neuropathy amongst former war prisoners. J Neurol Neurosurg Psychiatry. 1982; 45(10):861-5. PMC: 491588. DOI: 10.1136/jnnp.45.10.861. View

Laforenza U, Patrini C, Alvisi C, Faelli A, Licandro A, Rindi G . Thiamine uptake in human intestinal biopsy specimens, including observations from a patient with acute thiamine deficiency. Am J Clin Nutr. 1997; 66(2):320-6. DOI: 10.1093/ajcn/66.2.320. View

Sechi G, Serra A . Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442-55. DOI: 10.1016/S1474-4422(07)70104-7. View

Ryan A, Goldsmith L . Nutrition and the skin. Clin Dermatol. 1996; 14(4):389-406. DOI: 10.1016/0738-081x(96)00068-5. View

Suzuki S, Kumanomido T, Nagata E, Inoue J, Niikawa O . Optic neuropathy from thiamine deficiency. Intern Med. 1997; 36(7):532. DOI: 10.2169/internalmedicine.36.532. View

DASTUR D, Santhadevi N, Quadros E, Avari F, Wadia N, DESAI M . The B-vitamins in malnutrition with alcoholism. A model of intervitamin relationships. Br J Nutr. 1976; 36(2):143-59. DOI: 10.1079/bjn19760068. View

Bendich A, Cohen M . Vitamin B6 safety issues. Ann N Y Acad Sci. 1990; 585:321-30. DOI: 10.1111/j.1749-6632.1990.tb28064.x. View

Franca Jr M, DAbreu A, Zanardi V, Faria A, Lopes-Cendes I, Nucci A . MRI shows dorsal lesions and spinal cord atrophy in chronic sensory neuronopathies. J Neuroimaging. 2008; 18(2):168-72. DOI: 10.1111/j.1552-6569.2007.00193.x. View

Kumar N . Nutritional neuropathies. Neurol Clin. 2007; 25(1):209-55. DOI: 10.1016/j.ncl.2006.11.001. View

10.

Feit H, GLASBERG M, Ireton C, Rosenberg R, THAL E . Peripheral neuropathy and starvation after gastric partitioning for morbid obesity. Ann Intern Med. 1982; 96(4):453-5. DOI: 10.7326/0003-4819-96-4-453. View

11.

Gorson K, Herrmann D, Thiagarajan R, Brannagan T, Chin R, Kinsella L . Non-length dependent small fibre neuropathy/ganglionopathy. J Neurol Neurosurg Psychiatry. 2007; 79(2):163-9. DOI: 10.1136/jnnp.2007.128801. View

12.

Desjardins P, Butterworth R . Role of mitochondrial dysfunction and oxidative stress in the pathogenesis of selective neuronal loss in Wernicke's encephalopathy. Mol Neurobiol. 2005; 31(1-3):17-25. DOI: 10.1385/MN:31:1-3:017. View

13.

Poloni M, Mazzarello P, Laforenza U, Caramella C, Patrini C . Thiamin contents of cerebrospinal fluid, plasma and erythrocytes in cerebellar ataxias. Eur Neurol. 1992; 32(3):154-8. DOI: 10.1159/000116814. View

14.

Camdessanche J, Jousserand G, Ferraud K, Vial C, Petiot P, Honnorat J . The pattern and diagnostic criteria of sensory neuronopathy: a case-control study. Brain. 2009; 132(Pt 7):1723-33. PMC: 2702838. DOI: 10.1093/brain/awp136. View

15.

Lauria G, Pareyson D, Grisoli M, Sghirlanzoni A . Clinical and magnetic resonance imaging findings in chronic sensory ganglionopathies. Ann Neurol. 2000; 47(1):104-9. View

16.

Koike H, Iijima M, Mori K, Hattori N, Ito H, Hirayama M . Postgastrectomy polyneuropathy with thiamine deficiency is identical to beriberi neuropathy. Nutrition. 2004; 20(11-12):961-6. DOI: 10.1016/j.nut.2004.08.002. View

17.

May W . Nutritional sensory neuronopathy. An emerging new syndrome. Arch Neurol. 1984; 41(5):559-60. DOI: 10.1001/archneur.1984.04050170109028. View

18.

LAWRENCE Jr W . Nutritional consequences of surgical resection of the gastrointestinal tract for cancer. Cancer Res. 1977; 37(7 Pt 2):2379-86. View

19.

Koffman B, Greenfield L, Ali I, Pirzada N . Neurologic complications after surgery for obesity. Muscle Nerve. 2005; 33(2):166-76. DOI: 10.1002/mus.20394. View

20.

Gibb W, Gorsuch A, Lees A, Yudkin J . Reversible coma in Wernicke's encephalopathy. Postgrad Med J. 1985; 61(717):607-10. PMC: 2418334. DOI: 10.1136/pgmj.61.717.607. View