Nutritional diseases of the

nervous system

Nivedita Mpt (Neuro)

Thiamine Deficiency
• Thiamine (vitamin B1) is a water-soluble vitamin present in most
animal and plant tissues.

• Neuropathy due to thiamine deficiency, known as beriberi

• Beriberi may manifest with heart failure (wet beriberi) or without

heart failure (dry beriberi).
etio
deficiency of thiamine or vitamin B1
• chronic alcohol abuse
• malnutrition,
• starvation,
• Inflammatory bowel disease
Clinical features of thiamine deficiency;
• distal sensory loss,
• burning pain,
• paraesthesias
• muscle weakness in the toes and feet
Wernicke-Korsakoff syndrome
• A common complication of a thiamine deficiency
Wernicke-Korsakoff syndrome is a term that encompasses two different
syndromes;
• Wernicke encephalopathy and Korsakoff syndrome.

• Wernicke encephalopathy is characterized by an acute confusional

state
• Korsakoff syndrome is characterized by confabulation, memory loss,
and gait abnormalities
causes
• primarily seen in alcoholics
Other common causes;
Eating disorders (anorexia)
Terminal cancer
Inflammatory bowel disease
Bowel obstruction
AIDS
Systemic disorders like tuberculosis, uremia
pathophysiology
Thiamine mediates pyruvate metabolism, and its deficiency can lead to;
• elevated lactate which can lead to;
• edema,
• neuronal loss, and
• reactive gliosis throughout the brain.
• brain atrophy
C/F
clinical triad consisting of;
 altered mental status (i.e., confusion or dementia),
nystagmus
ataxia

diplopia, painless vision loss, amnesia

agitation, anger, hallucinations
Diagnosis:
• history and clinical findings
• neuro imaging - CT and MRI of the brain

management:
• Prophylactic thiamine administration (high dose thiamine at 500 mg-
1500 mg, IV, three times daily for at least 3 days.)