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 Case Of Neuropathy  



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Author14 Posts
  #1

A 67-year-old man has had numbness and tingling in the hands and feet for 3 weeks. He lives in a homeless shelter and is well fed. He has been treated for pulmonary tuberculosis for 5 months with isoniazid, rifampin, ethambutol, and pyrazinamide. He is compliant with his medication regimen but continues to abuse alcohol. His temperature is 37 C (98.6 F), blood pressure is 134/74 mm Hg, pulse is 69/min, and respirations are 19/min. He is well nourished but depressed and irritable. There is decreased sensation to pain and touch in the hands and feet in a stocking-glove distribution. Which of the following is the most likely nutritional deficiency?

A ) Folic acid

B ) Niacin

C ) Vitamin A

D ) Vitamin B1 (thiamine)

E ) Vitamin B2 (riboflavin)

F ) Vitamin B6

G ) Vitamin B12 (cyanocobalamin)

H ) Vitamin C

I ) Vitamin D

J ) Vitamin E

K ) Vitamin K





  #2

F) Vit. B6.


  #3

F



  #4

I'd go with B-6 (pyridoxine) too. While alcohol abuse makes the deficiency possible, as it does the deficiency of certain other vitamins, isoniazid increases the likelihood of pyridoxine deficieny alone.



  #5

F


  #6

F


  #7

The Classic sign of B6 deficiency is increased irritability, convulsions, and peripheral neuritis. Although convulsion is not present.........
Also the patient is on isoniazid therapy


  #8


D
  • Thiamine (vitamin B-1) deficiency
    • Dry beriberi is characterized by severe burning dysesthesias (feet more than hands), weakness and wasting (distal more than proximal), trophic changes (shiny skin, hair loss), and acrodistal sensory loss in a graded fashion typical of dying back polyneuropathies.

    • Some patients do not become symptomatic, possibly because they are absorbing thiamine produced by bacteria in the large intestine. However, one half become symptomatic by 7 weeks; by 15 weeks, axonal changes start to appear histologically.

    • The neuropathy begins with fatigue and loss of sensation, pain, and heaviness in the legs. Then, pretibial edema develops, along with glove-and-stocking paresthesias and difficulty with tasks such as climbing stairs and standing on 1 leg.

    • If the thiamine deficiency is long standing, muscles on the dorsum of the feet atrophy and paralysis can ensue.

    • Difficulty with talking or swallowing may also be noted.



  #9

Pyridoxine (vitamin B-6) deficiency

  • The presentation includes seborrheic dermatitis, cheilosis, glossitis, nausea, vomiting, weakness, and dizziness.

  • Neurologic examination shows decreased proprioception and vibration sense with spared pain and temperature sensations; normal strength; decreased or absent Achilles reflex and decreased patellar reflex.

  • Ataxia, if present, is sensory.



  #10

B6 for sure


  #11

B6


  #12

Fsmiling face


  #13

it is vitamin B1
www.wrongdiagnosis.com/p/pe...athy/book-diseases-11a.htm


  #14

B6 due to INH

alcohol mainly causes folate not vit B12 def








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