Neurological involvement with Whipple's disease

Whipple's disease is an inflammatory illness primarily afflicting middle-aged men. Although originally seen as a disease of intestinal malabsorption, it may affect any body system causing numerous signs and symptoms. These are due to infiltration of macrophages containing sickleform particles which stain PAS-positive. Definitive diagnosis is made by biopsy, and treatment is with broad-spectrum antibiotics. There seems to be an infectious component to the disease although defective immunologic responses may be implicated. Exact etiology is unknown. Although a rare illness, there has recently been increased recognition of this disease. Neurological involvement occurs with dissemination of lesions to the nervous system. Symptoms are quite varied but most often include dementia. As is apparent from the patient history, early diagnosis and treatment is imperative. Even without symptoms, there should probably be treatment for central nervous system involvement since neurological manifestations are often fatal. The case study presented illustrates a multisystem illness. The neurological presentation includes peripheral neuropathy, cranial nerve involvement, brainstem dysfunction, endocrine disturbance, thalamic or pituitary symptoms, and changes in cerebral function. Nursing measures reinforce the importance of the role of primary nursing for patient care and the necessity of comprehensive nursing care plans. Management problems were alleviated by providing consistency and continuous orientation, by involving the patient and his family in the plan of care, and by establishing a safe and consistent environment. Nursing process can improve and enhance patient responses, family coping ability, and the quality of care given. A "difficult" patient can help to expand nursing knowledge as well as promote personal growth and satisfaction.(ABSTRACT TRUNCATED AT 250 WORDS)