Deficit of B12 vitamin can arise at pernicious anemia (owing to insufficient secretion mucous a stomach of an internal factor of Kastl, the caused autoimmune reaction, more rare hereditary factors or a tumor of a stomach), after total removal of a stomach or an ileectomy, at helminthoses, unbalanced food (at vegetarians).
Neurologic disturbances include:
the damage of a spinal cord (funicular myelosis) with preferential involvement of pyramidal ways and ways of deep sensitivity in back columns which is clinically shown revival of tendon jerks, pathological-foot signs, paresis, a sensitive ataxy, dysfunction of pelvic bodies;
the polyneuropathy which is shown loss of Achilles reflexes, decrease in painful sensitivity as socks and gloves, sometimes weight loss of muscles of shins and feet;
atrophy of optic nerves;
The main difficulties of diagnosis arise when neurologic symptoms develop before emergence of anemia. In these cases the diagnosis of a funicular myelosis is confirmed by detection of an akhiliya (absence or decrease in hydrochloric acid and pepsin) in a gastric juice and megaloblasts at a marrow puncture, and also decrease in level of B12 vitamin in blood. Administration of B12 vitamin (1000 mkg intramusculary daily within 10 days, then 1000 mkg once a month) leads to gradual recovery of neurologic functions within several months.
Leukoses represent the tumors arising from the hemopoietic cells of marrow. Defeat of a nervous system can be connected with an infiltration of a meninx (meningoleykemiya) or focal deposits of tumor cells in brain substance. Meningoleykemiya is shown by meningitis symptoms — a headache, nausea, vomiting, rigidity of cervical muscles, sometimes irritability, drowsiness, oppression of consciousness, epileptic seizures. Quite often cranial nerves and roots of spinal nerves suffer. In a debut of a disease or during an aggravation intracraneal hemorrhages are possible. Many patients have a syndrome of the increased viscosity of blood caused by sharp increase in quantity of leukocytes in peripheral blood. It is shown by acoustical and visual disturbances, a headache, an ataxy, drowsiness, an adynamia, oppression of consciousness, sometimes passing disturbances of cerebral circulation.
The multiple myeloma can lead to a prelum of a spinal cord due to distribution of process from vertebrae. More often the department of a spinal cord is surprised nizhnegrudny, the lumbar department and a horse tail is more rare. Emergence of signs of a compression of a spinal cord is usually preceded by months-long dorsodynias. Defeat of peripheral nerves is connected with adjournment of amyloid in vasa nervorum, infiltratsiy nerves myeloma cells or amyloid or with development of paraneoplastic process. Often the multiple or isolated mononeuropathy meets (the syndrome of a carpal tunnel is especially characteristic).
Neurologic disturbances are inherent to acute hepatic porphyrias, first of all the acute alternating porphyria. The acute alternating porphyria usually is shown on 2 — the 3rd decade of life by attacks which are quite often connected with reception of medicines (for example, streptocides, barbiturates, other antiepileptic means, benzodiazepines, analginum, pyramidon, etc.). In addition to medicines, alcohol, arsenic, lead, a low-calorie low-carbohydrate diet, infections, operative measures, fluctuations of a hormonal background (periods, pregnancy) can provoke an attack. The first symptom often are abdominal pains of the skhvatkoobrazny or aching character. Sometimes they are the cause for diagnosis of an acute abdomen or intestinal impassability and carrying out an operative measure on an abdominal cavity. Operation, especially under a barbituric anesthesia, can lead to fast development of a heavy polyneuropathy. Vomiting, a lock, diarrhea, sinus tachycardia, paroxysmal arrhythmias, arterial hypertension, mental disorders are quite often noted (alarm, a depression, a hypomaniacal state, sleep disorders). In hard cases the delirium and oppression of consciousness, generalized convulsive attacks develop. The most dangerous complications of a porphyria are connected with a polyneuropathy which main manifestation is quickly accruing sluggish tetraparesis. In hard cases trunk muscles, including respiratory muscles are involved, third, facial, bulbar cranial nerves are surprised. Often symptoms of peripheral vegetative insufficiency (orthostatic hypotension, rest tachycardia, digestive tract paresis) develop. The lethal outcome is caused by sudden death, paralysis of respiratory muscles, a heavy bulbar syndrome. If the patient survives, perhaps complete recovery, but it can stretch for several years. The diagnosis is confirmed by urine coloring change which happens in a bladder or out of an organism (svezhevydelenny urine can have normal coloring). Coloring of urine accelerates under the influence of a sunlight therefore the jar with urine should be put on a window sill ("podokonnikovy" test). Coloring varies from pink till saturated red or red-brown color ("color of the Burgundian wine"). It is also possible to confirm the diagnosis by means of research of predecessors of porphyrines in urine. Treatment includes use of high doses of glucose (to 600 g/days) and drugs gem (for example, gemarginat). Apply propranolol to treatment of arterial hypertension and tachycardia (anaprilin) or other beta-blockers. For treatment of pain in mild cases are limited to paracetamol, aspirin or drugs of codeine, in heavy — it is necessary to appoint narcotic analgetics. Reduction of pain, stopping of vomiting and excitement are promoted by aminazine, to recovery of motive functions and the prevention of contractures — early active remedial gymnastics and massage.