title: Acute presentation of dizziness in vitamin B12 deficient old patient of cardiac disease: a case report.
abstract: BACKGROUND
  Neuropsychiatric and hematological manifestations of vitamin B12 deficiency are well known. The present report highlights the biochemical basis for the impaired synthesis of DNA and neurological disorders associated with vitamin B12 deficiency.
  
  
  METHODS
  We present a case of an old patient who developed acute ataxia, dizziness and imbalance 2 days after pacemaker implantation in a cardiac care unit.
  
  
  RESULTS
  On evaluation, the patient was found to have low vitamin B12 levels (121 pmol/l) with raised plasma homocysteine levels (28 μmol/l) and methylmalonic acid levels (17 μmol/l). Neurological examination revealed signs and symptoms of peripheral neuropathy. CT scan of the brain was found to be normal. The usual hematological presentation was absent in this case. The patient responded dramatically to parenteral vitamin B12 supplementation.
  
  
  CONCLUSIONS
  Though frequent, the vitamin B12 deficiency often goes unnoticed in elderly population. So, with this report we emphasize that deficiency of serum vitamin B12 levels should be suspected and evaluated in elderly patients presenting with neuropsychiatric symptoms.
authors.affiliation: GB Pant Hospital, Room 418, Dept of Biochemistry, Academic Block, Jawahar Lal Nehru Marg, New Delhi, India. bhawna172@gmail.com
authors.forename: Bhawna
authors.initials: B
authors.lastname: Singh
authors.forename: Sarika
authors.initials: S
authors.lastname: Arora
mesh_terms: D000368:Aged; D004244:Dizziness / Q000150:complications*; D006331:Heart Diseases / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D014806:Vitamin B 12 Deficiency / Q000150:complications*