An important segment of neurologic medicine, and one that is
seen with great frequency in general hospitals, are disorders in
which a global disturbance of cerebral function (encephalopathy) results
from failure of some other organ system—heart and circulation,
lungs and respiration, kidneys, liver, pancreas, and the endocrine
glands. Unlike the diseases considered in Chap.
37, in which a genetic abnormality affects the metabolic functions
of many organs and tissues including the brain, the cerebral disorders
discussed in this chapter are strictly secondary to derangements
of the visceral organs themselves. They stand at the interface of
internal medicine and neurology.
Relationships of this type, between an acquired disease of some
thoracic, abdominal, or endocrine organ and the brain, have rather
interesting implications. In the first place, recognition of the
neurologic syndrome may be a guide to the diagnosis of the systemic
disease; indeed, the neurologic symptoms may be more informative
and significant than the symptoms referable to the organ primarily
involved. Moreover, these encephalopathies are often reversible
if the systemic dysfunction is brought under control. Neurologists
must therefore have an understanding of the underlying medical disorder,
for this may provide the means of controlling the neurologic part
of the disease. In other words, the therapy for what appears to
be a nervous system disease lies squarely in the field of internal
medicine—a clear reason why every neurologist should be
well trained in internal medicine. Of more theoretical importance,
the investigation of the acquired metabolic diseases provides new
insights into the chemistry and pathology of the brain. Each visceral
disease affects the brain in a somewhat different way and, because
the pathogenic mechanism is not completely understood in any of
them, the study of these metabolic diseases promises rich rewards
to the scientist.
Table 40-1 lists the main acquired metabolic
diseases of the nervous system according to their most common modes
of clinical expression. Not included are the diseases caused by
nutritional deficiencies and those caused by exogenous drugs and
toxins, which can be considered metabolic in the broad sense; these
are discussed in the following chapters.
Table 40-1 Classification
of the Acquired Metabolic Disorders of the Nervous System in Adults |Favorite Table|Download (.pdf)
Table 40-1 Classification
of the Acquired Metabolic Disorders of the Nervous System in Adults
|I. Metabolic diseases presenting as a syndrome of confusion,
stupor, or coma|
|E. Hepatic failure|
|F. Reye syndrome|
|H. Disturbances of sodium, water balance, and osmolality|
|J. Other metabolic encephalopathies: acidosis due to diabetes
mellitus or renal failure (see also inherited forms of acidosis,
in Chap. 37); Addison disease|
|K. Hashimoto disease steroid-responsive encephalopathy|
|II. Metabolic diseases presenting as a progressive extrapyramidal
|A. Acquired hepatocerebral degeneration|
|B. Hyperbilirubinemia and kernicterus|
|III. Metabolic diseases presenting as cerebellar ataxia|
|C. Celiac sprue disease...|
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessMedicine Full Site: One-Year Subscription
Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.
Pay Per View: Timed Access to all of AccessMedicine
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.