RESUMO
The authors present a case of dietary vitamin B12 deficiency in a patient with multiple sclerosis. A simple schemata for evaluating patients for vitamin B12 deficiency is included as a clinical aid for physicians.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Esclerose Múltipla/complicações , Deficiência de Vitamina B 12/etiologia , Adulto , Protocolos Clínicos , Árvores de Decisões , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Masculino , Anamnese , Psicoterapia , Vitamina B 12/uso terapêutico , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/terapiaRESUMO
Quantified lesion scores derived from MRI correlate significantly with neuropsychological testing in patients with multiple sclerosis (MS). Variables used to reflect disease severity include total lesion area (TLA), ventricular-brain ratio, and size of the corpus callosum. We used these general measures of cerebral lesion involvement as well as specific ratings of lesion involvement by frontal, temporal, and parieto-occipital regions to quantify the topographic distribution of lesions and consequent effects upon cognitive function. Lesions were heavily distributed in the parieto-occipital regions bilaterally. Neuropsychological tests were highly related to all generalized measures of cerebral involvement, with TLA being the best predictor of neuropsychological deficit. Mean TLA for the cognitively impaired group was 28.30 cm2 versus 7.41 cm2 for the cognitively intact group (p less than 0.0001). Multiple regression analyses revealed that left frontal lobe involvement best predicted impaired abstract problem solving, memory, and word fluency. Left parieto-occipital lesion involvement best predicted deficits in verbal learning and complex visual-integrative skills. Analysis of regional cerebral lesion load may assist in understanding the particular pattern and course of cognitive deficits in MS.