ABSTRACT
Intravenous glucose administration is the most common cause of hypophosphataemia in hospitalised patients. While most of these cases are asymptomatic, severe hypophosphataemia, when combined with phosphorus depletion, can cause acute neuropathy that mimics Guillain-Barré syndrome. A malnourished patient who received intravenous hyperalimentation (IVH) without intravenous phosphate (IP) developed hypophosphataemia and acute sensorimotor neuropathy. F waves in the peripheral nerve trunk were absent or diminished, while nerve conduction velocities were nearly normal. The sural nerve biopsy revealed the presence of some subperineurial oedema and mild axonal atrophy. Prompt IP administration reversed the patients' neurological symptoms and normalised F waves. Our data suggest that hypophosphataemia plays a role in the pathogenesis of neuropathy that develops in patients following IVH without IP.
Subject(s)
Hypophosphatemia/etiology , Malnutrition/therapy , Parenteral Nutrition, Total/adverse effects , Peripheral Nervous System Diseases/etiology , Ataxia/etiology , Colitis, Ulcerative/complications , Diabetes Complications , Diarrhea/complications , Dysarthria/etiology , Humans , Male , Malnutrition/complications , Middle Aged , Muscle Weakness/etiology , Myocardial Infarction/complications , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/drug therapyABSTRACT
INTRODUCTION: Miliary dissemination is a rare form of brain metastasis. The clinical and pathologic features of this form are unclear. METHODS: We report a 66-year-old man with miliary brain metastases from adenocarcinoma of the lung, describing MRI and neuropathologic findings in the context of previously reported cases. RESULTS: Initial disorientation progressed to an apallic state within 6 months. Although, CT with administration of contrast agent failed to demonstrate any lesions, MRI with Gd-DTPA administration showed multiple enhancing miliary nodules in the cerebral cortex, basal ganglia, thalamus, cerebellum, and brainstem. Some of those nodules also could be seen on T2-weighted imaging without Gd-DTPA, but were difficult to identify conclusively. A histopathologic examination at autopsy disclosed diffusely distributed miliary tumor nodules in a perivascular distribution without surrounding focal edema or reactive gliosis. Notably, this patient with miliary brain metastases developed disorientation followed by unconsciousness, which overshadowed other focal neurologic signs at that time. CONCLUSION: We should consider this pattern of brain dissemination when a cancer is associated with unexplained disturbance of consciousness.
