Neurology of Nutritional Deficiencies

Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d

Children receiving maintenance dialysis (chronic kidney disease (CKD) stage 5d) have unique risk factors for micronutrient deficiency or toxicity. Children receiving chronic dialysis often require specialized diet plans that may provide more than the recommended daily allowance (RDA) of water-soluble vitamins and micronutrients, with or without the addition of a kidney-friendly vitamin. The following is a comprehensive review of current literature on disorders of micronutrients in this population including those of water-soluble vitamins (vitamin C and vitamin B complexes) and trace elements (copper, selenium, and zinc) and has three areas of focus: (1) the risk factors and clinical presentations of disorders of micronutrients, both deficiency and toxicity, (2) the tools to evaluate micronutrient status, and (3) the central role of renal dietitians in optimizing nutritional status from a micronutrient perspective.

Methylcobalamin Deficiency Presenting as Thalamic Syndrome in the Elderly: Association or Chance?

Vitamin deficiency is common in the geriatric population and is responsible for majorly imbalanced hematological, neurological, and neuropsychiatric functioning. Methylcobalamin deficiency or vitamin B12 deficiency can be underestimated in some cases and be misdiagnosed as other illnesses, such as thalamic syndrome. Timely diagnosis of this deficiency is essential, especially in the geriatric population, as it might cause irreversible structural brain damage. This is also presented as elevated levels of homocysteine and methylmalonic acid. Clinically, it presents with the following symptoms: lower sensitivity levels to touch and light, psychosis, paresthesia, anemia, imbalance, fatigue, cognitive disturbances, difficulty remembering, and confusion. Symptoms are usually progressive and worsen over a period of time. In this case report, we present the case of a 62-year-old male with clinical symptoms of numbness and tingling in the right side of the body. The neurological presentations resembled left thalamic infarct, but the underlying reason was methylcobalamin deficiency.

Idiopathic Copper Deficiency Induced Myeloneuropathy

Idiopathic nutritional deficiencies are often overlooked in patients with no history of malabsorption. However, it may lead to severe neurologic dysfunction that can sometimes be irreversible. We present a case in which early recognition of copper deficiency has led to a better outcome for the patient, who presented with acute myeloneuropathy.

A 45-year-old male with no significant history of malnutrition or malabsorption presented with complaints of acute encephalopathy, bilateral wrist drop, bilateral tingling and weakness in his hands as well as urinary incontinence. Workup upon arrival was nonrevealing, the patient was treated initially as presumed AIDP (acute inflammatory demyelinating polyradiculopathy), and he underwent plasmapheresis with no response. Since the patient did not respond to plasmapheresis and he had a significantly low folate levels with initial labs. Further nutritional workup was done, which revealed low copper (levels of 0.45), vitamins A, E, and B1. The patient was also tested for celiac which was negative, underwent upper endoscopy and colonoscopy which were both not significant. Decision was made to treat patient early with IV copper infusion as symptoms were deemed most likely due to copper deficiency. The patient received a total of 4 IV doses, after which the patient had a significant clinical response after infusion therapy and repeat copper levels revealed an increase as well (levels of 0.71). Prior to discharge, the patient had significant improvement in wrist drop as well as symptoms of tingling and numbness.

Despite being a trace element, copper deficiency can cause significant neurologic impairment. Furthermore, early recognition has proved to be imperative in neurologic recovery and supplementation has proven to be successful in improving patient’s quality of life.