A 67-year-old man with atherosclerotic cardiovascular disease on pravastatin 40 mg daily presents with progressive cognitive decline and proximal muscle weakness over 3 weeks. Vital signs: BP 138/82, HR 78, RR 16, Temp 37°C, SpO2 98%. Creatine kinase is elevated at 850 U/L; LDL cholesterol is 65 mg/dL (goal achieved). Brain MRI demonstrates acute white matter changes. He denies fever or recent infection. Which statin-related adverse effect is most likely responsible for these findings?
- A)Secondary vitamin D deficiency from statin-mediated CYP3A4 inhibition
- B)Accumulation of neurotoxic sterol intermediates from HMG-CoA reductase blockade
- C)Direct immune-mediated inflammation of myelin sheaths
- D)Statin-induced myopathy progressing to central nervous system involvement
- E)Excessive cholesterol depletion impairing myelin maintenance and CNS functionGABARITO
Explicação
While rare, excessive statin use in elderly patients can cause severe cholesterol depletion, which is critical for myelin synthesis and neuronal function. This can result in cognitive impairment, white matter disease, and neuropathy. The brain synthesizes its ... Ver explicação completa e trilha adaptativa →