1/6. pellagra encephalopathy following B-complex vitamin treatment without niacin.pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.- - - - - - - - - - ranking = 1keywords = pellagra (Clic here for more details about this article) |
2/6. Alcoholic pellagra encephalopathy combined with Wernicke disease.Clinical and postmortem findings of a case that had combined alcoholic pellagra encephalopathy and Wernicke disease are described. This 51-year-old malnourished and chronic alcoholic man presented with progressive mental deterioration, pellagra dermatitis, hypertonus of the neck and other musculatures, myoclonic jerks with bizarre involuntary movements, in addition to total external ophthalmoplegia and gait disturbance. After administration of multivitamins, including thiamine and nicotinamide, these neurologic abnormalities were dramatically improved in a few days. However, the patient died thereafter because of sepsis associated with pneumonia. Postmortem examination revealed marked abnormalities in CNS, characterized by diffuse atrophy of gray matter and widespread neuronal degeneration and characteristic central chromatolysis in pontine nuclei, dentate nuclei, cranial nerve nuclei in the brain stem, Betz cells of the cerebral cortex, and Clarke's column and anterior horn cells of the spinal cord. There were also atrophy and gliosis of the mammillary bodies, degeneration and vascular proliferation of periaqueductal gray matter, and massive gliosis around the third ventricle. These neuropathological changes were compatible with symptoms of both alcoholic pellagra encephalopathy and Wernicke's disease, but they were also strongly suspected on clinical grounds.- - - - - - - - - - ranking = 7keywords = pellagra (Clic here for more details about this article) |
3/6. The clinical spectrum of alcoholic pellagra encephalopathy. A retrospective analysis of 22 cases studied pathologically.A retrospective clinical study of 22 heavy alcohol drinkers is reported in which postmortem study showed diffuse chromatolysis of neurons identical to that found in neurological pellagra, associated in 13 cases with marchiafava-bignami disease and/or Wernicke-Korsakoff disease. The clinical features included confusion and/or clouding of consciousness, marked oppositional hypertonus ('gegenhalten') and myoclonus. Because of the frequent coexistence of other alcoholic encephalopathies in the same patient, alcoholic pellagra was often unrecognized. Fifteen patients received thiamine and pyridoxine therapy without niacin. It appeared to aggravate the neurological state or to trigger the development of alcoholic pellagra encephalopathy in 9 cases. The relationship between pellagra occurring during thiamine and pyridoxine therapy and 'nicotinic acid deficiency' is discussed. Multiple vitamin therapy should be given in the treatment of undiagnosed encephalopathies in alcoholic patients.- - - - - - - - - - ranking = 8keywords = pellagra (Clic here for more details about this article) |
4/6. Chronic alcoholism: report of an autopsy case and comparison with pseudoulegyric type of hepatocerebral degeneration.An autopsy case diagnosed as chronic alcoholism was reported. He clinically showed progressive neurological illness. His CNS lesions were composed of disseminated necrotic foci in the cerebral cortices with many Alzheimer type II astrocytes, pachymeningitis hemorrhagica interna, and lesions similar to pellagra and wernicke encephalopathy. Some clinical and pathological analogous features between chronic alcoholism and pseudoulegyric type of hepatocerebral degeneration were discussed.- - - - - - - - - - ranking = 1keywords = pellagra (Clic here for more details about this article) |
5/6. marchiafava-bignami disease, striatal degeneration, and other neurological complications of chronic alcoholism in a Japanese.A Japanese man with a variety of neurological complications, had drunk Japanese rice wine (sake) daily for about 25 years. There was a progressive development of parkinsonism, cerebellar ataxia, and mental deterioration by the time he was 32. He died of pneumonia at age 50 and the autopsy revealed marchiafava-bignami disease (MBD), striatal degeneration, pseudolaminar sclerosis of Morel, atrophy of the corpus mamillare and pons, cortical cerebellar atrophy, pseudopellagra, and polyneuropathy. This is the first case of MBD in a Japanese related to the ingestion of Japanese "sake", and it is also a rare case in that almost all of the neurological complications seen with chronic alcoholism were apparent. Striatal degeneration seems to be a rare complication of chronic alcoholism.- - - - - - - - - - ranking = 1keywords = pellagra (Clic here for more details about this article) |
6/6. pellagra among chronic alcoholics: clinical and pathological study of 20 necropsy cases.Twenty cases of pellagra, diagnosed on neuropathological grounds, were found amont 74 necropsy cases of chronic alcoholism. Although these patients had presented with various mental, neurological and gastrointestinal symptoms, the diagnosis of pellagra had not been established clinically because, in the majority, there were no skin lesions. It is emphasised that whenever chronic alcoholics exhibit certain mental, neurological or gastrointestinal symptoms, one should strongly suspect pellagra even in the absence of skin lesions (pellagra sine pelle agra).- - - - - - - - - - ranking = 4keywords = pellagra (Clic here for more details about this article) |