Neurobiology of vitamin C: Expanding the focus from antioxidant to endogenous neuromodulator.

Objective: To report a case of Parkinsonism rapidly responsive to intravenous replacement of vitamin C and zinc. Case Summary: A 66-year-old man with Parkinsonism, pleural effusion, and bipolar disorder was found to have low serum vitamin C and zinc levels. Intravenous replacement of these micronutrients led to resolution of the movement disorder in less than 24 hours. Discussion: Parkinsonism has been associated with vitamin C deficiency, and recent cases of scurvy complicated by Parkinsonism have responded well to intravenous replacement of vitamin C. In this case, deficiency of zinc may have contributed to the development of a movement disorder. The likely pathophysiology of, and treatment recommendations for, Parkinsonism linked to deficiencies of vitamin C and zinc are reviewed. Conclusions: Whereas vitamin C has a strong link with Parkinsonism, the potential role of zinc has only been suspected. This case report highlights some of the potential links between zinc deficiency and Parkinsonism.

Ascorbate- and Zinc-Responsive Parkinsonism:

Patients with vitamin C deficiencies and parkinsonism can show rapid improvement with vitamin C replacement therapy.

Parkinsonism and Vitamin C Deficiency.

Neuropsychiatry has a long and fascinating history as a discipline at the interface between neurology and psychiatry that combines clinical observations with modern investigational techniques. Historically, organic psychiatry has focused on clinical syndromes with regional connections affecting the four cortical lobes and the corpus callosum. Behavioural neurology has developed from early observations of classical neurocognitive syndromes, including aphasia, alexia, apraxia, agnosia and Gerstmann syndrome. A number of common neurological conditions often present with specific psychiatric symptoms: traumatic brain injury, cerebrovascular disease, brain tumours, epilepsy, movement disorders, infectious diseases and autoimmune neurological disorders such as multiple sclerosis, systemic lupus erythematosus and autoimmune encephalopathies. The differential diagnosis between delirium, dementia and pseudodementia can pose significant challenges. Finally, several toxic, metabolic and endocrine disorders can have clinically relevant neuropsychiatric manifestations. 

Neuropsychiatric Disorders

From the Caravels to the Wards: Scurvy and Schizophrenia.

The Neuropsychiatry of Scurvy

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The Neuropsychiatry of Scurvy