Neurological complications of diabetes mellitus, anemia, alcoholism, collagenous disorders DM, 6.12.2018.

Pernicious, megaloblastic anaemia B12 vitamin deficits, chronic gastritis, lack of intrinsic factor- malabsoption Neuropaties, polyneuropathies Ataxia- spinal type, dorsal columns demyelinitang lesions, myelopathy - Subacute combined degeneration Th: supplementation B12 or folic acid

Alcohol and nervous system Acute intoxication Changes in behavior, agressivity, incoordination of movement and gait, slurred speach Drowsiness, stupor, coma, problems with breathing

Alcohol and nervous system Abstinence and withdrawal syndrome Tremulousness, hallucinations seizures, confusion psychomotor and autonomic overactivity, which develops several hours or days after an addictive drinker abstains from alcohol

Alcohol and nervous system Delirium tremens In 10% starts with seizures Profound confusion, gross tremor, hallucinations, autonomic overactivity – fever, tachycardia, dilated pupils 48-96 hours after cessation of drinking

Alcohol and nervous system 3. Alcohol and dementia Chronic abuse of alcohol – cognitive deficit (loss of neurons, brain atrophy) Wernicke´s encefalopathy (hemorhagic) Korsakov´s syndrom

Alcohol and nervous system Wernicke´s encefalopathy Confusion, eye movement problems, ataxia – dysarthria, ataxia of body and extremities, residual signs Loss of neurons, axons, myelin, small hemorrhagies – corpora mamillaria, around aqueductus, III. And IV. ventricles Th.: Thiamin 100 mg/day im.,iv. B-vitamins

Alcohol and nervous system Korsak´s syndrom Amnestic syndrom with amnesia, confabulations Marchiafava-Bignami syndrom Demyelinisation of corpus callosum Confusion, seizures, dementia

Alcohol and nervous system Alcoholic degeneration of cerebellum-- cerebellar atrophy Alcoholic polyneuropathy Alcoholic myopathy Acute necrotisans myopathy Chronic myopathy

Diabetes mellitus Hypoglycemia General signs, headache Neurological signs – seizures, coma, acute hemiparesis

DM Repeating hypoglycaemia: loss of intelect, cognitive disturbances, dementia Hyperglycemia Metabolic encefalopathy DM – higher risk of stroke

Diabetic polyneuropathy After 5-10 years of dibatis diseases course 10% - earlier than DM Pathogenesis – metabolic changes and ischemic changes of vasa nervorum (hyalinisation of the wall of vesels) Metabolic – earlier problems with sensitivity, myelin fibers are resistant agains ischemia

Diabetic polyneuropathy Symmetric, mainly distal Lower extremities – more often Loss of proprioception, ataxia Neuropatic pain

Systemic lupus erythematodes General, skin , heart, pulmonary, renal symptoms, myalgie Neurological– 25-75%, 3% - the first Headache, depression, confussion, halucinations, hemiparesis, transversal spinal cord lesions, mononeuritis, polyneuritis, polymyositis, brain infarctions Stroke- brain infarctions Lab tests: Lupoid-like anticoagulans antiphospholipid antibodies CSF – pleocytosis EEG – diffuse abnormalities, MRI – multiple subcortical white matter lesions