vitamin-b-12 and Muscle-Weakness

Topics: Anemia, Pernicious; Diagnosis, Differential; Humans; Intrinsic Factor; Magnetic Resonance Imaging; Male; Memory Disorders; Middle Aged; Muscle Weakness; Spinal Cord; Vitamin B 12; Vitamin B 12 Deficiency

Pernicious anemia can result in significant hematologic and neurologic impairments due to a reduction in cobalamin absorption. Typically thought to be a disease of elderly whites, a growing body of literature has documented the disease in blacks and in younger age groups. We describe a case of a young black woman with gradually progressive lower extremity paresthesias, weakness, and ataxia as the primary presenting symptoms of pernicious anemia. This case is presented to make emergency physicians aware of pernicious anemia as a cause of ambulatory dysfunction in younger patients. We review the current body of literature on the diagnosis and management as well as evidence that the demographic profile of the disease is changing. Furthermore, in women of reproductive age, there is the potential for significant fetal and infant morbidity.

Topics: Adult; Anemia, Pernicious; Emergency Service, Hospital; Female; Humans; Injections, Intramuscular; Mobility Limitation; Muscle Weakness; Paresthesia; Vitamin B 12; Vitamin B Complex

Pernicious anaemia is the most common cause of cobalamin deficiency. Nervous disorders associated with cobalamin deficiency are neuropathy, optic atrophy, dementia and myelopathy (subacute combined degeneration). In this case, symptoms are those of posterior and lateral column dysfunction of the spinal cord, with diminished vibratory sensation, ataxia, weakness of limbs, hyperreflexia, extensor plantar response and spasticity. Macrocytosis and anaemia are often lacking. There is an inverse correlation between the degree of anaemia and the extent of nervous impairment. The most sensitive tool for the diagnosis of cobalamin deficiency is the serum cobalamin level. But a normal cobalamin assay does not fully exclude cobalamin deficiency. Levels of serum methylmalonic acid and total homocysteine are useful as ancillary tests in the diagnosis. Treatment is based on intramuscular injections of vitamin B12.

Topics: Anemia, Pernicious; Ataxia; Humans; Injections, Intramuscular; Muscle Weakness; Spinal Cord Diseases; Vitamin B 12; Vitamin B 12 Deficiency