Ataxic gait following total gastrectomy for gastric cancer

Abstract

A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal. This was followed by weekly intramuscular injections of vitamin B12 for another 2 wk and oral administration of vitamin B12 three times per day. After comprehensive rehabilitation for 4 wk, she showed sufficient improvements in strength and ataxic gait, enabling her to return to her normal daily activities.

Subacute combined degeneration with vitamin B12 deficiency in a patient with bulimia nervosa

“…Subacute combined degeneration has also been described in association with multiple conditions such as total gastrectomy for early gastric cancer [8], infective endocarditis [9], occult celiac disease with copper deficiency [10], helicobacter pylori-induced gastritis with anti-intrinsic factor antibodies [11] and in the setting of nitrous oxide abuse (N2O, laughing gas) which is thought to impair vitamin B12 metabolism [2]. In our case, the patient was very reluctant to admit self-induced vomiting following periods of binging or compulsive eating.…”