Reversible Vitamin B12 Deficiency Presenting with Acute Dementia, Paraparesis, and Normal Hemoglobin

Abstract

Vitamin B12 is essential for neurological function and its deficiency is associated with many neuropsychiatric disorders. We report the case of a previously healthy 53-year-old male patient presenting with delirium and multiple neurological findings. Complete blood analysis indicated megaloblastic anemia. All infectious causes were excluded owing to negative cultures (blood and urine). Tests for human immunodeficiency virus, syphilis, and toxoplasma were also negative. Metabolic workup showed severe vitamin B12 deficiency, decreased reticulocyte count, and increased direct bilirubin and lactate dehydrogenase. Intramuscular injection of cobalamin was started, and the patient showed significant improvement.

Thalassemia minor presenting with vitamin B₁₂ deficiency, paraparesis, and microcytosis

“…After further diagnostic workup, severe vitamin B 12 deficiency was identified and he responded to cobalamin replacement therapy. 14 …”

Cerebral White Matter Demyelination in Vitamin B12 Deficiency: A Case Report

“…There may be simultaneous involvement of the cranial, peripheral, and autonomic nerves also, and as such visual disturbances, abnormal smell, heart rate variability, and abnormal reflexes including those of the viscera, erectile dysfunction, and orthostatic hypotension are also reported. • Neuropsychiatric issues 4,15,16 MRI is the imaging of choice and may show spinal dorsal column signal change as well as cerebral white matter signal changes. 1,2,4,6,16 Brain atrophy may be seen in advanced cases.…”

Optic neuropathy as a presenting feature of vitamin B-12 deficiency: A systematic review of literature and a case report

“…Like any disease, patients with VitB12 deficiency can present with atypical manifestations. Some reported findings include dysphagia, hyperpigmentation, psychosis, and acute dementia [ [30] , [31] , [32] , [33] ].…”