Acute bilateral useless hand syndrome: a rare presenting manifestation of vitamin B₁₂deficiency

Abstract

We report a case of bilateral useless hand syndrome, a rare presenting manifestation of vitamin B12 deficiency. A 38-year-old man, a strict vegetarian and a teacher by occupation, presented with acute onset clumsiness of both hands while performing fine movements. Detailed history-taking, examination of the patient and relevant investigations (complete blood count, serum vitamin B12 and MRI of the cervical spinal cord) were carried out. Laboratory analysis was suggestive of vitamin B12 deficiency and MRI demonstrated a lesion involving the posterior columns of the cervical cord. The patient was diagnosed as a case of non-compressive cervical myelopathy predominantly involving the posterior column due to vitamin B12 deficiency. Acute bilateral useless hand syndrome can be a rare presenting feature of vitamin B12 deficiency.

Can vitamin B12 deficiency manifest with acute posterolateral or posterior cord syndrome?

“…Until now there are only two case reports mentioning acute onset neurological manifestations. 3,4 An acute onset reversible extra-pyramidal syndrome (parkinsonism) with mild myeloneuropathy secondary to vitamin B12 deficiency has been described.…”

“…2 There are only two case reports of acute neurological presentation of vitamin B12 deficiency. 3,4 We hereby describe a case series of five patients of vitamin B12 deficiency who presented with acute neurological manifestations over a duration 1 year.…”