CNS Path of Nutritional Disorders - Parks Flashcards
what groups of pts are at risk of nutritional based CNS path?
- alcoholics
- Cancer patients–hyperemesis, can’t keep food down, won’t eat
- gastric bypass– loss of IF production from stomach, impaired B12 absorption, low B12 intake
- early pregnancy, need folate
- Alzheimers
Beriberi is a def of which b vitamin?
b1 thiamine
what are the symptoms of beriberi?
WERNICKE'S ENCEPHALOPATHY wt. loss muscle waisting and pain edema neuropathy cardiac dilation and high output cardiac failure OPTHALMOPLEGIA
What are the Sx of Wernicke’s?
Opthalmoplegia
Cerebellar ataxia
mental impairment: confused and disoreinted
What is the pathological change in Wernicke’s?
Foci of hemorrhage and necrosis in the mamillary bodies and walls of the thrid and fourth ventricles
What is the clinical presentation of Wernicke-Korsakof?
new memory impaired so people confabulate
Where do we see more degeneration in Wernicke-Korsakoff?
neurons in the walls of the fourth ventricle and medial thalamic nuclei
Why do the mamillary bodies show up on CT in WE?
increased blood from hemorrhage, edema, and INCREASED VASCULARITY
Thiamine deficiency produces a diffuse decrease in cerebral utilization of…
glucose
Decrease in cerebral utilization of glucose leads to damage of which cellular structure?
mitochondria
How do you treat WE?
IM or IV thiamine
What gastric disorders besides bypass will result in b vitamin def?
chronic gastritis
gastric carcinoma
persistent emesis
How do you make a diagnosis of WE?
Imaging of the mamillary bodies on CT and clinical findings
High methylmalonic acid indicates a deficiency of which vitamin?
vitamin b12
V. b12 deficiency has what types of symtpoms?
loss of vibrational and position sense
Loss of vibration and position sense is damage to which column?
posterior columns
Loss of pain and temp sensation is damage to which column
lateral
what is the path caused by a b12 def?
demyelination of the neurons
Patients with b12 deficiency have what type of spinal cord deterioriation?
subactue combined demyelinating degeneration
T/F: combined demyelination of the cord is irreversible if not treated quickly
true
where is IF produced?
parietal cells of the fundus of the stomach
WHere is b12 absorbed?
distal ileum when bound to IF
When will we see b12 def?
- pernicious anemia aka atrophic gastritis, gastrectomy for cancer of stomach, ulcers, etc.
- impaired malabsorption from intestines
- bariatric surgery for obesity
- poor diet from vegetarianism
Depletion in Vit. D may result in muscle pain because….
2ry hypocalcemia
What are the seven important factors in nutrition that can prevent Alzhemier’s?
- minimize sat. fats
- lots of veggies
- vitamin E from foods not supps
- lots of b12; check levels regularly
- DON’T USE IRON OR COPPER IN YOUR MULTIVITAMIN
- limit aluminum intake
- include aerobic exercise
which b vitamins slow Alzheimer’s progression?
folic acid
b6
b12
