From the Guidelines
Acute nutritional axonal neuropathy does not typically cause mild elevation of white blood cells (WBC) with normal red blood cells (RBC) and protein in cerebrospinal fluid (CSF). In nutritional neuropathies, such as those caused by vitamin B12, thiamine, or other nutrient deficiencies, CSF findings are generally normal 1. When CSF abnormalities are present in patients with neuropathy, they usually suggest alternative diagnoses like inflammatory or infectious processes. Mild CSF pleocytosis (elevated WBC) with normal protein and RBC would be more consistent with viral meningitis, early bacterial infection, or certain autoimmune conditions affecting the nervous system.
Some studies have discussed the neurological evaluation of patients with acute hepatic porphyrias, which can be complicated by an axonal motor neuropathy and paresis 1. However, these conditions are distinct from acute nutritional axonal neuropathy and do not typically present with mild elevation of WBC in CSF. Nutritional neuropathies primarily affect peripheral nerves through metabolic mechanisms rather than inflammatory processes, which explains why CSF composition typically remains unaltered.
Key points to consider in the diagnosis and management of neuropathies include:
- Progressive phase and symmetry of symptoms
- Presence of cranial nerve involvement or autonomic dysfunction
- Electrodiagnostic features of motor or sensorimotor neuropathy
- CSF findings, including protein levels and cell counts 1. If a patient with suspected nutritional neuropathy shows CSF abnormalities, clinicians should consider additional or alternative diagnoses and pursue appropriate testing for inflammatory, infectious, or autoimmune conditions.
From the Research
Acute Nutritional Axonal Neuropathy and Its Effects on WBC, RBC, and Protein in CSF
- Acute nutritional axonal neuropathy is a severe axonal polyneuropathy that can occur in patients with acute nutritional deficiency, often associated with alcoholism, bariatric surgery, or anorexia 2.
- The study by 2 found that patients with acute axonal neuropathy had normal cerebrospinal fluid (CSF) protein levels.
- However, there is no direct evidence in the provided studies to suggest that acute nutritional axonal neuropathy causes a mild elevation of white blood cell (WBC) count with normal red blood cell (RBC) and protein in CSF.
- The studies focus on the clinical, laboratory, and electrodiagnostic features of acute nutritional axonal neuropathy, as well as its prognosis and treatment 3, 4, 5, 6.
- It is essential to note that the provided studies do not specifically address the question of whether acute nutritional axonal neuropathy causes a mild elevation of WBC with normal RBC and protein in CSF.
Laboratory Abnormalities in Acute Nutritional Axonal Neuropathy
- Laboratory abnormalities in patients with acute nutritional axonal neuropathy may include low levels of thiamine, vitamin B6, and other micronutrients 2, 3.
- The study by 3 found that vitamin B1 was the most commonly low micronutrient, followed by vitamin B6 and folate.
- However, the studies do not provide information on the specific effects of acute nutritional axonal neuropathy on WBC, RBC, and protein in CSF.
Prognosis and Treatment of Acute Nutritional Axonal Neuropathy
- The prognosis of acute nutritional axonal neuropathy is guarded due to residual neuropathic pain and slow recovery of independent ambulation 3.
- Early recognition and prompt treatment with vitamin supplementation are essential to ensure an optimal outcome and minimize neurologic morbidity 4, 6.
- The studies emphasize the importance of identifying patients at risk and providing early diagnosis and timely medical assistance to prevent long-term complications.