Malabsorption Syndrome and Peripheral Neuropathy
RICHARD G. FARMER, M.D.
Department of Gastroenterology
NELSON G. RICHARDS, M.D.
Department of Neurology
THE differential diagnosis of peripheral neuropathy (polyneuritis) can be a difficult and frustrating problem. No specific cause is found in most instances. Because the problem is a perplexing one, rather cumbersome classifications of peripheral neuropathy have evolved, and thus the clinician may tend to give little attention to isolated diseased states associated with neuropathy.
Several chronic diseases are known to be associated with peripheral neuropathy, including chronic alcoholism, malnutrition, hypovitaminosis (particularly vitamin B-complex deficiencies), diabetes mellitus, amyloidosis, and carcinoma. Malabsorption syndromes (nontropical sprue, gluten-induced enteropathy) are generally mentioned in classifications but are not considered prominently. It is well known that megaloblastic anemia due to vitamin B12 deficiency can result in subacute combined degeneration of the spinal cord and neuropathy. The most common known cause of degeneration of the posterior and/or lateral column of the spinal cord is found in association with pernicious anemia. This neurologic picture may be present along with other disorders, for example nontropical sprue, a malabsorption state. Furthermore, the malabsorption syndrome may be associated with the neurologic picture of a peripheral neuropathy rather than posterior or lateral column involvement.
We have recently seen two patients with malabsorption syndrome and peripheral neuropathy. Because of the relative rarity, the prominent neurologic findings, and the importance of early diagnosis, we are reporting these two cases.
Report of Cases
Case 1. A 53-year-old man was examined at the Cleveland Clinic in August, 1963, because of progressive numbness and tingling of his hands and feet, present for 18 months. In addition, he. . .