tailieunhanh - Tropical Neurology - part 10

Suy dinh dưỡng năng lượng protein kết quả trong sự tham gia rộng rãi của hệ thống thần kinh tạo ra các dấu hiệu và triệu chứng liên quan đến thần kinh trung ương, hệ thần kinh ngoại vi và cơ. Các triệu chứng Neuropshychological là dấu hiệu của hệ thần kinh trung ương tham gia trong PEM | 484 Tropical Neurology 26 Fig. . Photograph of a patient with protein calorie malnutrition note edema of face hands and feet protuberent abdomen and pigmented skin over the legs courtesy of Dr. R. Kumar . Nutritional Deficiency Disorders 485 Clinical Features Acute Effect of PEM Protein energy malnutrition results in widespread involvement of the nervous system giving rise to signs and symptoms related to the CNS peripheral nervous system and muscles. Neuropshychological symptoms are the hallmark of CNS involvement in PEM. Apathy irritability attention deficit slow learning language disturbances poor social skills and blunted abstraction have been described. Listlessness apathy misery easy irritability and severe anorexia are striking in the acute stage of Kwashiorkor. Rarely features of myelopathy have been reported in juvenile Soft neurological signs in rural undernourished children have been reported to correlate with degrees of Peripheral nerve involvement is more pronounced in PEM which occurs in the vulnerable period . during the period of myelination of the peripheral nerves. The effect is negligible if PEM occurs later. Muscle wasting is a constant feature and more prominent in marasmus than Kwashiorkor. Generalized weakness hypotonia hyporeflexia occasional sensory abnormalities and autonomic dysfunction have been reported in PEM. Muscle involvement in PEM is characterized by generalized muscle weakness and wasting waddling gait difficulty in getting up wasting of the axillary folds slipping of the child through hands placed at axilla on attempting lifting off the floor. The large proximal muscles are more susceptible to PEM subserving as a readily available source of protein and energy during the period of malnutrition. Nearly all the symptoms and signs of PEM revert back to normal after dietary supplementation. 26 Delayed Effects of PEM The neurological and intellectual consequences of PEM have defied accurate assessment .