Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B12 deficiency (original) (raw)
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The peripheral neuropathy of vitamin B12 deficiency
Journal of The Neurological Sciences, 1984
Nerve conduction studies and sural nerve biopsy were performed on three patients with vitamin B12 deficiency and symptoms of peripheral neuropathy. The pathological findings were those of axonal degeneration; there was no evidence of demyelination. The patients were reviewed at intervals of 5–15 years commencement of treatment; progression of the neuropathy had been arrested by treatment, but in all cases residual neurological abnormalities persisted. In one patient with autonomic neuropathy, the postural hypotension resolved rapidly and fully with treatment.
Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report
Background: Vitamin B12 deficiency is a metabolic disorder with many causes. It often presents with megaloblastic anaemia and neurological disorders which entail prompt treatment. The diagnosis of Vitamin B12 deficiency is chal‑ lenging in resource limited‑settings due to limited access to diagnostic tools and unfamiliarity with the disease, owing to its rarity especially in young people. Case presentation: A 28 year old female Cameroonian presented with progressive burning painful sensations on the upper trunk, paraesthesia and numbness of the upper and lower limbs for a period of 5 years. Before presenting to us, she had consulted in numerous health institutions for which she had been treated for diverse pathologies with no relieve of symptoms. After clinical and laboratory evaluation, a diagnosis of vitamin B12 deficiency‑associated neuropathy was made. She was placed on oral vitamin B12 supplements at 2 mg daily for 3 months. Follow up was marked by good clinical recovery after 1 month of therapy. Conclusion: Vitamin B12 deficiency neuropathy is a rare debilitating disease that affects mostly the elderly. However; young adults with neuropathic symptoms warrant a high index of suspicion. Peripheral blood smears and complete blood counts are sufficiently diagnostic in resource‑limited settings.
Unusual neurological presentations of vitamin B12 deficiency
European Journal of Neurology, 2004
Vitamin B12 deficiency (B12D) has a wide variety of neurological symptoms and signs. However, cerebellar dysfunction and cranial neuropathies other than optic neuropathy have been rarely reported. Herein, we describe two cases of unusual neurological manifestations of B12D. One patient showed prominent hoarseness with vocal cord paralysis, myelopathy, and peripheral neuropathy. The other had gait disturbance, lateral gaze limitation and cerebellar dysfunction in addition to the typical manifestations of subacute combined degeneration. Vitamin B12 deficiency can rarely affect cerebellum and cranial nerves other than optic nerve.
Vitamin B12 Deficiency; Frequency of Neurological Manifestations in Quetta
THE PROFESSIONAL MEDICAL JOURNAL, 2017
To determine the frequency of neurological manifestations of vitamin B 12 deficiency and to observe the reversibility of the symptoms after the therapy. Study Design: Descriptive study. Study Design: Descriptive study. Setting: Medicine Department of Bolan Medical Complex Hospital Quetta. Period: One year that is from January 2012 to December 2012. Methodology: 46 patients presented to various OPDS of B.M.C.H.. The inclusion criteria for the patients to be studied were: Anemia, Neurological complaints. Results: Out of 46 patients 26(56%) were males and 20(43%) were the females with a mean age of (40) years.32 (69%) belonged to the rural areas. 45(97%) had mixed diets whereas only one 1(2.1%) young non Muslim was found to be pure vegetarian.32 (69%) patients presented with hematological as well as neurological complaints. 23(30%) had pancytopenia and 9(19.5%) had bicytopenia. 14(30%) presented with neurological complaints only as sacd 6 (13%), ataxia 8 (17%), sensorimotor neuropathies 36 (78%) and dementia 2 (4.3%). In signs glossitis was found in 6(13%), jaundice in 22 (47%), pallor in 32 (69%) proximal myopathy in 12 (26%) out of which 6 (13%) had shoulder girdle and 8 (17%) pelvic girdle myopathy. Impaired position sense was found in 18 (39%) patients and vibration sense in 21(45%) patients. other signs were pigmentation 2(4.3%) hypotonia in 6(13%) Spasticity in 2(4.3%) and Upgoing plantars in 6(13%) patients. Lhermittes sign could be elicited in only 2(4.3%) patients Optic neuritis and optic atrophy was found in 4(8.6%) patients who came with paraplegia and marked anemia. Rhombergs sign was positive in 8(17.3%) who came with clumsiness of gait. Hemoglobin (Hb %) was found to be low in 32(69%) with a mean of 7.2gm%.pancytopenia (anemia+leucopenia+thrombocytopenia) was found in 23(50%) of patients whereas bicytopenia was found only in 9(19.5%) of patients. Hypersegmented W.B.C were very carefully looked for and were found in 20(43%) of cases. ovalomegaloblasts were found in 32 (69%) of cases .both findings of ovalomegaloblasts and hypersegmented w.b.cs were found in 20 (43%). in the rest 14 (30%) the blood investigations were found to be normal. The next investigation in all patients was serum B 12 estimation, It was found that levels below 200pg/ml were found in 95% cases where only 2(4.3%) patients came with levels slightly above 205pg/ml and 210pg/ml. the response to therapy was recorded as reversible and irreversible. the irreversible features were sacd in 6 (13%), optic atrophy in 2 (4.3%), and dementia in 2 (4.3%) patients. the partially reversible features were myelopathy 10 (21%) numbness and paraesthesias 30 (65%) optic neuritis inn 2 (4.3%) patients were assessed on a duration of 24 weeks. partially reversible features were ataxia, in 6 (13%) patients myelopathy in 2 (4.3%) patients dementia in 2 (4.3%) patients and paraesthesias and numbness in 6 (13%) patients over a period of 24 weeks. Conclusion: It is concluded from my study that the neuropsychiatric manifestations of vitamin B 12 deficiency are common among the elderly age group, either with or with out the evidence of anemia.
Neurological Manifestations of Vitamin B12 Deficiency: Study of a Series of 43 Cases
Background: Vitamin B12 deficiency can affect the nervous system, with various neurological manifestations causing diagnostic difficulties, especially when the blood count and vitamin B12 dosage are normal. Materials and Methods: We propose to analyze the epidemiological, clinical, para-clinical and evolutional profiles of 43 patients with neurological manifestations due to vitamin B12 deficiency, hospitalized at the department of neurology of Bab El Oued University Hospital Algiers.
B12 deficiency with neurological manifestations in the absence of anaemia
BMC Research Notes, 2015
Background: Vitamin B 12 deficiency is often diagnosed with hematological manifestations of megaloblastic macrocytic anemia, which is usually the initial presentation. Neurological symptoms are often considered to be late manifestations and usually occur after the onset of anemia. Sub acute combined cord degeneration, which is a rare cause of myelopathy is however the commonest neurological manifestation of vitamin B 12 deficiency. Case presentation: We present a case of a 66 year old Sinhalese Sri Lankan female, who is a strict vegetarian, presenting with one month's history suggestive of Sub-acute combined cord degeneration in the absence of haematological manifestations of anaemia. Her Serum B 12 levels were significantly low, after which she was treated with hydroxycobalamine supplementation, showing marked clinical improvement of symptoms, with normalization of serum B 12 levels. Hence, the diagnosis of vitamin B 12 deficiency was confirmed retrospectively. Conclusion: Vitamin B 12 deficiency could rarely present with neurological manifestations in the absence of anaemia. Therefore a high index of suspicion is necessary for the early diagnosis and prompt treatment in order to reverse neurological manifestations, as the response to treatment is inversely proportionate to the severity and duration of the disease.
Vitamin B12 Deficiency In Spinal Cord Injury: A Retrospective Study
The Journal of Spinal Cord Medicine, 2003
Background/Objective: Vitamin B 12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI). This retrospective study describes vitamin B 1 2 deficiency in SCI. Methods: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B 1 2 testing over the last 1 0 years. Results: Probable vitamin B 1 2 deficiency was noted in 1 6 patients with SCI. Twelve patients had subnormal serum vitamin B 12 levels (< 220 pg/ml), whereas 4 patients had low-normal vitamin B 12 levels (< 300 pg/ml) with neurologic and/or psychiatric symptoms that improved following vitamin B 1 2 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 1 6 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition , 3 of the 1 6 SCI patients presented with depression and fatigue , 2 had worsening pain , 2 had worsening upper limb weakness, and 2 had memory decline. Of the 1 2 patients with subnormal serum vitamin B 12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B 1 2 , macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anem ia was identified in 7 of the 1 6 patients and macrocytic red blood cells were found in 3 of the 1 6 patients. Only 1 of the 1 6 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B 12 deficiency (ie, partial gastrectomy) ; none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit) , including reversal of anemia (5 patients) , improved gait (4 patients) , improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients) , strength gain (1 patient), and reduced numbness (1 patient). Conclusion: It is recommended that physicians consider vitamin B 1 2 deficiency in their patients with SCI, particularly in those with neurologic and/ or psychiatric symptoms. These symptoms often are reversible iftreatment is initiated early.
Vitamin B12 neuropathy in a 6 year old
Archives of Disease in Childhood, 1984
Gross neuropathy consequent upon selective malabsorption of vitamin B12 was diagnosed in a 6 year old Bangladeshi girl brought to Great Britain for further investigation of an unexplained illness of three years' duration. The initial peripheral blood count was normal. Treatment with vitamin B12 has led to substantial recovery.
Reversible myelopathy with vitamin B12 deficiency
Vitamin B12 defiiency causes haematological, gastrointestinal, psychiatric and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord, characterised by degeneration of the lateral and posterior columns, is often found due to vitamin B12 defiiency. We report SCD occurring in a 57-year-old man who presented with a 2.5–month history of gradually progressing tingling in the figers and toes and neck ache. Laboratory data revealed vitamin B12 defiiency and magnetic resonance (MR) imaging of the cervical spinal cord demonstrated abnormal hyperintense signal changes on T2- weighted imaging of the posterior columns. In our case, follow-up MR imaging fidings correlated well with clinical outcome after treatment with vitamin B12 supplements. Neurological symptoms in vitamin B12 defiiency are frequent. Early spinal MR imaging assists in the early diagnosis and treatment of the disease.
Journal of Psychology & Psychotherapy, 2015
Vitamin B12 or cynacobalamin is an important water soluble vitamin which plays a key role in erythropoiesis, proper nervous system functioning and for the metabolism of carbohydrate, fat and protein. Patients with cynacobalamin deficiency may present with haematological, gastro-intestinal, oral, dermatological, psychiatric and neurological disturbances. We present a case of sub-acute combined degeneration (SACD) of spinal cord in a fortynine year old female presenting with one month history of progressive symptoms of lower limb paraesthesia, sensory deficit, psychotic symptoms and postural instability. This case report is unusual as it elucidates the characteristic triad, i.e., haematological, psychiatric and neurological symptoms in sub-acute combined degeneration of spinal cord (SACD) associated with B12 deficiency, correlation of its clinical manifestations, electrophysiological signs, laboratory investigations (especially biomarkers of B12 status) and spinal magnetic resonance (MR) imaging in establishing the diagnosis, treatment outcomes, and potential therapeutic relevance of vitamin B12 replacement therapy in symptoms remission.