Unusual neurological presentations of vitamin B12 deficiency

Abstract

Vitamin B(12) deficiency (B(12)D) 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 B(12)D. 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 B(12) deficiency can rarely affect cerebellum and cranial nerves other than optic nerve.

Serum vitamin B12 deficiency and hyperhomocystinemia: A reversible cause of acute chorea, cerebellar ataxia in an adult with cerebral ischemia

“…Involuntary movements like tremors, twitches, chorea, myoclonus or combination have been reported in about 50% of the infants with infantile cobalamin deficiency [4][5][6]. In adults with vitamin B 12 deficiency, focal dystonia, chorea, parkinsonism, myoclonus and even ataxia have been documented as single case reports [3,[8][9][10][11].…”

“…The neurological manifestations are paraesthesia, sensory ataxia, weakness of limbs, dementia, optic atrophy, and mood disorders and commonly occur in the 5th to 7th decade. Cerebellar ataxia and extrapyramidal manifestations like dystonia and chorea have been documented infrequently in adults [2,3].…”

Rare Association Between Pernicious Anemia and Neurogenic Bladder – A Case Report and Literature Review

“…dementia, urinary incontinence and orthostatic hypotension) . 9 Laboratory confirmation is made with the dosage of cobalamin deficiency biomarkers, such as the red blood cell mean corpuscular volume (MCV), serum cobalamin level, plasma holotranscobalamin, serum methylmalonic acid (MMA) levels and serum homocysteine levels. 10 In the present case we assessed the MCV and serum cobalamin level, which were compatible with megaloblastic anemia.…”

“…1 All physicians should keep this disease in mind, because it is universaland can cause irreversible neurologic damage, anemia, osteoporosis and cardiovascular diseases. [2][3][4][5][6][7][8][9][10] Pernicious anemia is the most common cause of vitamin B 12 deficiency, and it is also called Biermer disease, an autoimmune disease characterized by destruction of gastric mucosa and by the presence of auto-antibodies, anti-intrinsic factor and anti-gastric parietal cell 1,, . [11][12][13] Patients with neurogenic bladder are at increased risk for numerous complications, such as hydronephrosis, vesicoureteral reflux, renal failure, urinary tract infections, renal stones, bladder cancer, sexual dysfunction and uretral deformities.…”

Vitamin B12 Deficiency as a First Sign of Acquired Horizontal Pandular Nystagmus

“…In contrast to frequent optic nerve involvement, eye movement disorders in B12D, which is extremely rare, has only been reported 11 times in the literature [2][3][4][5][6][7][8][9][10]. We aim to present a case with conjugate horizontal pendulernystagmus due to vitamin B12 deficiency.…”