Neurological deficits in a patient with selenium deficiency due to long-term total parenteral nutrition

摘要

Dear Sirs, The neurological symptoms of selenium deficiency are unclear. We report a patient with neurological deficits associated with selenium deficiency following long-term total parenteral nutrition (TPN). A 40-year-old man was referred complaining of visual loss followed by slurred speech and staggering gait that had developed over the preceding 2 months. He had suffered from Crohn's disease for 22 years and had received home TPN management for 3 years following extensive surgical resection of the gastrointestinal tract. As a result of short-bowel syndrome, he received only a little water and gastric coating agents. Neurological examination showed visual loss, brady-arthria, truncal and limb ataxia, and loss of limb proprio-ception. Physical examination showed curly hair and whitened nail beds on the fingers and toes, which had developed 3 months before the neurological manifestations (Fig. 1a, b). Brain magnetic resonance (MR) imaging and MR spectroscopy appeared normal.