Dementia-peripheral neuropathy during combined deficiency of vitamin B12 and folate. Light microscopy and ultrastructural study of sural nerve.
We present a case of a 56 year old woman who, in consequence of repeated surgical resections of the small bowel, developed a slowly progressive and mainly motor polyneuropathy affecting the lower limbs. The polyneuropathy due to a combined deficiency of vitamin B12 and folate, was associated with intellectual deterioration, involving especially the mnesic functions. Light microscopy and ultrastructural study of sural nerve revealed: marked reduction of every order of myelinated fibers: aspects of wallerian-like myelin degeneration; various stages of myelin leaflet delamination into the cytoplasm of Schwann cells and/or macrophages; lack of alterations attributable to a primary axonal degeneration. The morphological results suggest a primary demyelination, followed secondarily by either axonal changes or some aspects of wallerian-like degeneration.
D001921:Brain / Q000473:pathology; D005260:Female; D005494:Folic Acid Deficiency / Q000150:complications* / Q000209:etiology; D006801:Humans; D007082:Ileum / Q000601:surgery; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications; D013127:Spinal Nerves / Q000473:pathology*; D013497:Sural Nerve / Q000473:pathology* / Q000648:ultrastructure; D014057:Tomography, X-Ray Computed; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000209:etiology