Metabolic/Nutritional Disorders with Neurological Consequences

Question 1

Pallegra - what is it

Answer 1

disease from deficiency in niacin, B complex vitamin (B3)

Question 2

4 D’s of Pallegra

Answer 2

Diarrhea
Dermatitis
Dementia
Death

Question 3

Wernicke’s Syndrome/Encephalopathy - what is it

Answer 3

Complication of thiamine (B1) deficiency
Most often associated with chronic alcoholism but occurs with poor nutrition
Alcohol and non alcohol related causes

Question 4

Wernicke’s Syndrome/Encephalopathy - Two of the non-alcoholic related causes can be what

Answer 4

Post op from bariatric surgery 
Hyperemesis graveidarum (with preg)

Question 5

Wernicke’s Syndrome/Encephalopathy - s/s - neuro impairments

Answer 5

Confusion
Ataxia with possible tremors
Nystagmus, Diplopia, Ptosis

Question 6

Karsakoff’s Syndrome - what is it

Answer 6

Chronic memory disorder caused by deficiency of thiamine (B1)

Question 7

Karsakoff’s Syndrome and Wernicke’s

Answer 7

Many think KS is the chronic phase of WE, so WE occurs first and then KS is the chronic extension of the disease process

Question 8

Karsakoff’s Syndrome - s/s

Answer 8

Worse than Wernicke’s - worse cognitively

Question 9

Alcoholic Neuropathy - what is it

Answer 9

Peripheral nerve damage as a result of chronic alcohol abuse

Question 10

Alcoholic Neuropathy - Pathophysiology

Answer 10

Alcoholism and poor nutrition leading to deficiencies in thiamine, folate, niacin, B6, B12, and vitamin E
All are important for proper nerve function

Question 11

Peripheral diabetic neuropathy - what is it

Answer 11

Nerve damage throughout the body occurring secondary to diabetes
Often occurs first in distal LE

Question 12

Phenylketonuria (PKU) - what is it

Answer 12

Rare inherited disease that causes amino acid build up in the body
amino acid = phenylalanine

Question 13

PKU - what causes the build up of the amino acid

Answer 13

The gene responsible for creating the enzyme to break down the amino acid is defective and leads to an elevated, toxic level

Question 14

PKU - pregnancy

Answer 14

If it is not controlled in the mother during pregnancy, it can affect the baby’s development even if the baby does not inherit the defect!!!

Question 15

PKU - Neuro impairments

Answer 15

Difficulty in decision making, problem solving planning, lower IQ, slower thinking
Seizures, tremors, tics or stiffness of limbs

Question 16

PKU - what are babies born to PKU mothers at risk for

Answer 16

Intellectual disability because exposure to phenylalanine amino acid
Delays mental and social skills
Can also see hyperactive bx problems

Question 17

Pallegra - s/s and functional limitations

Answer 17

Ataxia and weakness (difficulty walking, balance)
Paralysis of extremities (difficulty walking, transfers)
Peripheral neuritis (nerve pain)

Question 18

Wernicke’s Syndrome/Encephalopathy - Classic triad of s/s

Answer 18

Ataxia
Confusion
Eye problems

Question 19

Wernicke’s Syndrome/Encephalopathy - Possible lesion sites

Answer 19

Brainstem tegmentum
Hypothalamus
Medulla
Dorsomedial nucleus of thalamus
Cerebellum

Question 20

Karsakoff’s Syndrome - Volume deficits in ___

Answer 20

mamillary bodies
thalamus
cerebellum
pons
hippocampus
FRONTAL LOBE (cog issues)

Question 21

Karsakoff’s Syndrome - Triad

Answer 21

Ataxia
Nystagmus
Confusion
Similar to WE except KE is distinct because of chronic memory/cognitive impairments

Question 22

Alcoholic Neuropathy - Neurological impairments

Answer 22

Symptoms begin distally and mvoe proximally as disease progresses
Presents as a polyneuropathy (both sides of the body)

Question 23

Peripheral diabetic neuropathy - Neuro Impairments

Answer 23

Pain
Numbness
Weakness
Reduced ability to feel temp changes
Loss of reflexes
Muscle atrophy
Feeling like they are wearing socks or gloves

Question 24

Peripheral diabetic neuropathy - typically presents as a

Answer 24

Polyneuropathy - also called distal symmetric neuropathy or sensorimotor neuropathy
Nerve damage in the arms and legs with feet and legs likely being affected before the hands and arms

Question 25

Peripheral diabetic neuropathy - typically starts with what symptoms

Answer 25

sensory symptoms first, then weakness

Question 26

Peripheral diabetic neuropathy - loss of sensation due to what

Answer 26

Loss of sensation due to disruption of both large fibers (touch, vibration) and small fibers (pain, temp)