title: Vitamin B12 Deficiency and Elevated Folate Levels: An Unusual Cause of Generalized Tonic-Clonic Seizure.
abstract: BACKGROUND
  Vitamin B12 deficiency leads to abnormal myelination or demyelination, resulting in sub-acute combined degeneration, peripheral neuropathy, and psychiatric problems, including delusions, hallucinations, cognitive changes, depression, and dementia. Vitamin B12 deficiency also leads to brain shrinkage and neurodegenerative disorders.
  
  
  METHODS
  We report the case of a 49-year-old man presenting with new-onset seizures one and a half years following subtotal gastrectomy due to stage IV gastric adenocarcinoma. The patient did not have any history of head injury. Laboratory tests were negative for any metabolic derangements. There were no signs of infection. MRI brain and EEG were normal and there were no changes in medications.
  
  
  CONCLUSIONS
  In case of unexplained new-onset seizures, patients should be tested for vitamin B12 and folic acid levels and these should be done as part of the initial work-up.
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Sandeep Singh
authors.initials: SS
authors.lastname: Lubana
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Alfishawy
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Atkinson
mesh_terms: D001921:Brain / Q000473:pathology*; D005492:Folic Acid / Q000097:blood*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis
chemical_list: D005492:Folic Acid