The nervous system is undoubtedly complex and susceptible to a wide range of ailments and diseases. What is equally true, and perhaps even more impressive, is the effect that all the other systems of the body, their diseases, and the treatments of those diseases can have on the nervous system. Delving into the neurologic complications of systemic disease is a book in itself, and in fact, there are several available. This chapter is going to provide a framework (and a few examples) of how to think about whether a systemic process, including the treatments, can affect the nervous system.
One way to think about neurologic complications of systemic disease is to think of the different systems in the body that get diseased. Those systems include, but are not limited to, the cardiac, vascular, pulmonary/respiratory, gastrointestinal, renal, urologic, skeletal, hematologic, endocrine, dermatologic, and reproductive systems. Now think about the diseases of those systems. That gets overwhelming very quickly. To add to that burden, think of the treatments for those diseases. That is a bit more than the mind can handle. Now try to list and prioritize which systems and diseases are the most important in causing neurologic complications. Are those the only ones that need to be learned about? Of course not! An alternate, and maybe simplified, way to think about how the nervous system is affected by systemic disease is to think about the ways the nervous system can be affected. By thinking this way, one can give anticipatory guidance about systemic diseases and treatments. It also allows for quicker identification of the cause of symptoms and the resolution of symptoms.
The acronym VITAMINS, which has variations, is used to think of the differential diagnoses of the nervous system. It can also be used to think of the different ways the nervous system can be affected by systemic disease. Admittedly, thinking this way can lead to much overlap of categories; however, that is preferred to missing a complication.
|V ||Vascular – intracranial and extracranial |
|I ||Infectious/inflammatory |
|T ||Trauma/toxin |
|A ||Autoimmune/allergic |
|M ||Metabolic |
|I ||Inflammatory/ingestion/iatrogenic |
|N ||Neoplasm |
|S ||Structural |
It is important to remember that vascular system causes of neurologic symptoms can come from the heart, intracranial vessels, extracranial vessels, large vessels, small vessels, arteries, and veins. The most obvious primary vascular nervous system disease is related to the larger intracranial vessels and results in ischemia or hemorrhagic strokes. When discussing pediatric complications of systemic disease, it is typically not the larger intracranial vessels that are the problem. Common conditions that lead to nervous system complications from systemic disease arise from the heart (congenital defects of valves; abnormal chambers; abnormal or defective septae; pulmonary vasculature anomalies; and smaller vascular anomalies as seen in moyamoya, cavernomas, arteriovenous malformations, and angiomas). Those can be conditions in of ...