title: Vitamin B(12) deficiency with bilateral globus pallidus abnormalities.
abstract: OBJECTIVE
  To describe a case of vitamin B(12) deficiency with classic and rare clinical features and novel radiographic features.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Johns Hopkins Hospital neurology service.
  
  
  METHODS
  Middle-aged man with neuropathy, myelopathy,impaired cognition, and extrapyramidal signs.
  
  
  RESULTS
  The patient had neurologic and hematologic signs of vitamin B(12) deficiency, with elevated methylmalonic acid and homocysteine levels. Brain magnetic resonance imaging showed signal abnormality in the globi pallidi, as can be seen in inherited methylmalonic acidemia.The clinical and radiographic findings reversed with vitamin B(12) administration.
  
  
  CONCLUSIONS
  Vitamin B(12) deficiency can present with extrapyramidal symptoms and reversible bilateral globus pallidus abnormalities.
authors.affiliation: Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. asharri1@jhmi.edu
authors.forename: Anjail Z
authors.initials: AZ
authors.lastname: Sharrief
authors.forename: Joel
authors.initials: J
authors.lastname: Raffel
authors.forename: David S
authors.initials: DS
authors.lastname: Zee
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000150:complications* / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology; D005116:Extrapyramidal Tracts / Q000473:pathology; D005917:Globus Pallidus / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D014806:Vitamin B 12 Deficiency / Q000150:complications*