Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes.
OBJECTIVE
To study the clinical and laboratory features of patients admitted with vitamin B12 deficiency-related (B12def) neurological syndromes.


METHODS
A hospital-based retrospective and prospective study conducted at a referral teaching hospital.


METHODS
Consecutive patients admitted with vitamin B12 deficiency-related neurological disorders during a three-year period from June 2000 to May 2003 were included. Data regarding clinical and laboratory features were obtained. Follow-up was done at least six months following treatment with parenteral vitamin B12. Chi-square test was used for statistical analysis.


RESULTS
A total of 63 patients (52 males) with a mean age of 46.2 years were studied. The mean duration of symptoms at presentation was 10.3 months. Myeloneuropathy (54%) was the commonest neurological manifestation, followed by myeloneuropathy with cognitive dysfunction (34%), and peripheral neuropathy (9%). Neuropsychiatric manifestations and dementia were observed in 38% and 19% of patients respectively. All the patients had megaloblastic changes in the bone marrow smear. Eleven (17.5%) patients had both hemoglobin and the mean corpuscular volume (MCV) within the normal range. Follow-up after at least six months of therapy with parenteral B12 showed improvement in 54% patients.


CONCLUSIONS
A high index of suspicion of B12def is required in patients presenting with myelopathy, cognitive decline, or neuropathy. A normal hemoglobin or MCV does not exclude B12def; therefore, other tests such as bone marrow smear and serum vitamin B12 assay are essential, as the condition is often reversible with treatment.
Aaron
S
S
Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore 632-004, Tamil Nadu, India.
Kumar
Sudhir
S
Vijayan
J
J
Jacob
J
J
Alexander
M
M
Gnanamuthu
C
C
D000328:Adult; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D014805:Vitamin B 12 / Q000008:administration & dosage*; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
D014805:Vitamin B 12