Images in Clinical Medicine
Neurologic Manifestations of Vitamin B12 Deficiency
N Engl J Med 2003; 348:2208May 29, 2003
- Article
A 56-year-old woman presented with a four-month history of progressive cognitive decline, weakness, incoordination, and gait disturbance. She had a score of 12 of 28 on the Mini–Mental State Examination, moderate weakness, and severe ataxia; reflexes, vibratory sensation, and the sense of position were absent throughout her arms and legs. T2-weighted magnetic resonance imaging (MRI) of the brain demonstrated extensive areas of high-intensity signal in the periventricular white matter (Panel A, arrow). MRI of the spine showed a hyperintense signal along the posterior columns in all segments, including the lower portion of the cervical cord (Panel B, arrow). Laboratory tests revealed macrocytic anemia, hypersegmented neutrophils, a low serum vitamin B12 concentration (34 pg per milliliter [25 pmol per liter]), anti–intrinsic-factor antibodies, and abnormal results on the first stage of the Schilling test. Vitamin B12 injections rapidly improved cognitive function, and strength and walking also improved. Vitamin B12 deficiency causes a typical pattern of degeneration of the white matter in the central nervous system that can be manifested clinically as encephalopathy, myelopathy, peripheral neuropathy, and optic neuropathy.
Katalin Scherer, M.D.
Duke University Medical Center, Durham, NC 27710- Citing Articles (9)
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