hydroxocobalamin and Muscle-Weakness

Focal spinal cord lesions have been present in all previously reported cases of MRI appearances in myelopathy complicating vitamin B12 deficiency. We describe two further cases showing mild atrophy only and review the salient features of the previous 11 publications. MRI findings reflect quite closely the known pathological changes in this condition.

Topics: Adult; Aged; Atrophy; Female; Humans; Hydroxocobalamin; Magnetic Resonance Imaging; Male; Muscle Weakness; Neural Conduction; Paraparesis, Tropical Spastic; Sensation Disorders; Spinal Cord; Spinal Cord Diseases; Vitamin B 12 Deficiency

An 8-year-old girl presented with severe muscular weakness, peripheral neuropathy, ataxia, fever and macrocytic anaemia. Clinically, vitamin B(12) (cobalamin) deficiency was considered. Despite the lack of pre-treatment laboratory confirmation of the diagnosis, a therapeutic trial of hydroxocobalamin injections was begun. After several days, a partial clinical response was seen. Within 5 months all symptoms had resolved. After treatment was initiated, laboratory analysis of pre-treatment blood samples confirmed the presence of vitamin B(12) deficiency. Auto-antibodies to intrinsic factor and parietal cells, pathognomonic for pernicious anaemia, were confirmed. Vitamin B(12) deficiency owing to dietary deficiency is not uncommon in children in developing countries. Although nutritional deficiency might have played a role in our patient, this case illustrates that the neurological manifestations of pernicious anaemia can present at a young age in African populations.

Topics: Anemia, Pernicious; Ataxia; Child; Early Diagnosis; Female; Hematinics; Humans; Hydroxocobalamin; Muscle Weakness; Peripheral Nervous System Diseases; Vitamin B 12 Deficiency