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At 01:44 PM 2/26/96 -0600, Rene Delehanty <[log in to unmask]> wrote:
> which is now combined with horrible burning sensations
>in her extremities (legs especially). Does anyone else ever have these
>kinds of symptoms?
I keyed this in from the Merck Manual (16th ed):
Peripheral Neuropathy
...
Nutritional deficiency and metabolic disorders may result in polyneuropathy.
Deficiency of B vitamins is often the cause (eg, in alcoholism, beriberi,
pernicious anemia, isoniazid-induced pyridoxine deficiency, malabsorption
syndromes, and hyperemesis gravidarum). Polyneuropathy also occurs in
hypothyroidism, porphyria, sarcoidosis, amyloidosis, and uremia. Diabetes
mellitus causes several forms of neuropathy; sensorimotor distal
polyneuropathy (most common), multiple mononeuropathy, and focal
mononeuropathy (eg, of oculomotor or abducens cranial nerves).
...
Polyneuropathy is relatively symmetric; sensory, motor, and vasomotor fibers
often are involved simultaneously. (An acute, rapidly progressive form, the
Guillain-Barre syndrome, and hereditary neuropathies are discussed
separately below.) The most common form of polyneuropathy, seen with
metabolic disease (eg, diabetes mellitus, renal failure, malnutrition),
develops slowly, often over months or years; it frequently begins with
sensory abnormalities in the lower extremities. Abnormalities are often more
severe distally than proximally. Peripheral tingling, numbness, burning
pain, or deficiencies in joint proprioception and vibratory sensation often
are prominent. Pain is often worse at night and may be aggravated by
touching the affected area or by temperature changes. In severe cases,
objective signs of sensory loss, typically with stocking-and-glove
distribution, can be shown. The Achilles and other deep tendon reflexes are
diminished or absent. Painless ulcers on the digits or Charcot's joints may
be seen when sensory loss is profound. Sensory or proprioceptive deficits
may lead to gait abnormalities. Motor involvement results in distal muscle
weakness and atrophy.
The autonomic nervous system may be additionally or selectively involved,
leading to nocturnal diarrhea, bladder and bowel incontinence, impotence, or
postural hypotension. Vasomotor symptoms are variable. The skin may be paler
and drier than normal or there may be excess sweating and/or dusky
discoloration. Trophic changes are common in severe and prolonged cases;
they consist of smooth, shiny skin, pitted or ridged nails, and osteoporosis.
Uncommonly, an exclusively sensory polyneuropathy is seen, which begins with
peripheral pains and paresthesias and progresses centrally to a loss of all
forms of sensation. This occurs as a remote effect of carcinoma, especially
bronchogenic, after megadose intoxication with pyridoxine (B6), in
amyloidosis, hypothyroidism, myeloma, and uremia.
...
=======================================================================
Peripheral neuropathy is listed as one of the possible symptoms of celiac
disease, or gluten intolerance. CD is a malabsorption syndrome, and the
patient can become deficient in fat soluble vitamins and minerals, due to
damaged intestinal villi.
In the Celiac Sprue Association/USA flyer on celiac disease (Box 31700,
Omaha, NE 68131 402-558-0600) among the symptoms it lists peripheral
neuropathy as numbness and tingling in fingers and toes.
=======================================================================
A Medline abstract:
TI- [Celiac disease in adults revealed by sensory-motor neuropathy]
TI- <Original> Maladie coeliaque de l'adulte revelee par une neuropathie
sensitivo-motrice.
AU- Viader F; Chapon F; Dao T; Rivrain Y; Lechevalier B
CS- Service de Neurologie, CHRU de Caen.
JN- Presse Med; 24 (4) p222-4
PY- Jan 28 1995
AB- Central or peripheral nervous system complications are occasionally
observed in adult patients with celiac disease. Several mechanisms have
been proposed including vitamin deficiency, vascular inflammation and a
direct effect of gluten intolerance. Typical nerve fiber damage due to
demyelinization has been suggested. We observed a 65-year old woman
with a right peroneal nerve palsy superimposed on a diffuse peripheral
neuropathy who was found to have folic acid deficiency which in turn
led to the diagnosis of adult celiac disease. Electrophysiological and
histological studies demonstrated a predominantly demyelinating
peripheral neuropathy which responded first to parenteral folic acid
supplementation and second to a gluten-free diet. The mechanisms of
peripheral nerve damage in adult celiac disease are briefly discussed
and the possible role of folic acid deficiency is emphasized.
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