vitamin-b-12 and Optic-Nerve-Diseases

Vitamin B12 deficiency causes a wide range of hematological, gastrointestinal, psychiatric and neurological disorders. Hematological presentation of cobalamin deficiency ranges from the incidental increase of mean corpuscular volume and neutrophil hypersegmentation to symptoms due to severe anemia, such as angor, dyspnea on exertion, fatigue or symptoms related to congestive heart failure, such as ankle edema, orthopnea and nocturia. Neuropsychiatric symptoms may precede hematologic signs and are represented by myelopathy, neuropathy, dementia and, less often, optic nerve atrophy. The spinal cord manifestation, subacute combined degeneration (SCD), is characterized by symmetric dysesthesia, disturbance of position sense and spastic paraparesis or tetraparesis. The most consistent MRI finding is a symmetrical abnormally increased T2 signal intensity confined to posterior or posterior and lateral columns in the cervical and thoracic spinal cord. Isolated peripheral neuropathy is less frequent, but likely overlooked. Vitamin B12 deficiency has been correlated negatively with cognitive functioning in healthy elderly subjects. Symptoms include slow mentation, memory impairment, attention deficits and dementia. Optic neuropathy occurs occasionally in adult patient. It is characterized by symmetric, painless and progressive visual loss. Parenteral replacement therapy should be started soon after the vitamin deficiency has been established.

Topics: Cognition Disorders; Humans; Nervous System; Optic Nerve Diseases; Peripheral Nervous System Diseases; Subacute Combined Degeneration; Vitamin B 12; Vitamin B 12 Deficiency

To compare peripapillary retinal nerve fiber layer (RNFL) thicknesses measured by Cirrus HD optical coherence tomography (OCT) of patients with vitamin B12 deficiency with healthy controls and to evaluate the correlation between the peripapillary RNFL thickness and plasma vitamin B12 levels.. Forty-five patients (19 male and 26 female) with a diagnosis of vitamin B12 deficiency (patient group) and 45 age- and sex- matched healthy subjects (control group) were consecutively enrolled in this study. Average, temporal, nasal, inferior, and superior quadrant peripapillary RNFL thicknesses of each subject were obtained using the Cirrus HD OCT. Disc area (DA) and rim area (RA), central subfield thickness (CST), cube volume (CV), and cube average thickness (CAT) were also measured.. Mean age of each group was 33.1 ± 6.5 years (range: 21-45 years). Mean plasma vitamin B12 level was 114.8 ± 34.0 pg/mL in the patient group and was 405.1 ± 20.0 pg/mL in the control group (p < 0.001). The patient and control groups were similar regarding axial length, plasma folate levels, DA, RA, CST, CV, CAT, and RNFL thicknesses in superior, nasal, and inferior quadrants. However, average RNFL and RNFL in temporal quadrant were significantly thinner in the patient group than in the control group (p = 0.013 and p < 0.001, respectively). In addition, temporal (r = 0.356, p = 0.001) and average (r = 0.212, p = 0.045) peripapillary RNFL thicknesses were correlated with plasma vitamin B12 levels.. We have shown that, as in other non-glaucomatous optic neuropathies, temporal quadrant RNFL thickness was thinner in patients with vitamin B12 deficiency and it was correlated with plasma vitamin B12 levels. Further studies are warranted to clarify the clinical relevance of these findings and the effects of vitamin B12 replacement therapy.

Topics: Adult; Female; Glaucoma; Humans; Male; Middle Aged; Nerve Fibers; Optic Disk; Optic Nerve Diseases; Retina; Retinal Degeneration; Tomography, Optical Coherence; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

A 54-year-old man with Klinefelter's syndrome presented to the neuro-ophthalmology clinic with progressive painless visual blurring in the right eye over 2 years. He was receiving intramuscular testosterone therapy for hypogonadism and hypromellose for dry eye. Acuity was reduced bilaterally, and the right optic nerve head appeared pale and asymmetrically cupped. Optical coherence tomography revealed loss of retinal nerve fibre layer thickness in the right eye and visual field testing showed a developing right-ring scotoma. Blood tests showed vitamin B

Topics: Folic Acid; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Klinefelter Syndrome; Male; Middle Aged; Optic Nerve Diseases; Tomography, Optical Coherence; Vitamin B 12; Vitamins

Topics: Administration, Intranasal; Humans; Male; Middle Aged; Optic Nerve Diseases; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Adult; Alcohol Drinking; Folic Acid; Folic Acid Deficiency; Humans; Male; Nicotiana; Nutrition Disorders; Optic Nerve Diseases; Smoking; Tomography, Optical Coherence; Vision Disorders; Visual Field Tests; Visual Fields; Vitamin B 12; Vitamin B Complex

Neurological disorders secondary to vitamin B12 deficiency are polymorphic and diverse. There have been very few studies conducted in the Moroccan as well as in the African population. This study aims to describe the clinical, paraclinical, evolutionary features of neurological manifestations in patients with vitamin B12 deficiency within the Department of Neurology at the Moulay Ismail Military Hospital, Meknes over a period of 18 years (1999-2017). The study involved 06 women and 23 men, with an average age of 57 years. The mean time between symptom onset and diagnosis was 3 months. Neurological manifestation was indicative of vitamin B12 deficiency in 100% of cases. The average hemoglobin level was 10 g/dl, the mean corpuscular volume was 115 fl. Medullary megaloblastosis and atrophic gastritis were found in 95% and 90% of cases respectively. Regular electromyography (EMG), electroencephalography (EEG) and visual evoked potentials (VEP) showed subclinical peripheral and optic neuropathies. In 20 cases they were caused by Biermer's anemia. All the patients received parenteral Vitamin B12 with good outcome. These results demonstrate the importance of early diagnosis in patients with a potentially serious neuropsychiatric condition as well as of rapid substitution treatment which is the only therapeutic option to secure a good outcome.

Topics: Aged; Anemia, Pernicious; Electroencephalography; Electromyography; Evoked Potentials, Visual; Female; Humans; Male; Middle Aged; Morocco; Nervous System Diseases; Optic Nerve Diseases; Retrospective Studies; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Chronic deficiency of vitamin B

Topics: Animals; Cell Survival; Female; Neurons; Neuroprotective Agents; Optic Nerve Diseases; Rats; Rats, Long-Evans; Superoxides; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin K 3

Topics: False Positive Reactions; Homocysteine; Humans; Methylmalonic Acid; Optic Nerve Diseases; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; Vitamin B 12; Vitamin B 12 Deficiency

A 39-year-old man was admitted with a sudden visual loss in the left eye. Visual acuities were 10/10 on the right and 1/10 on the left. Fundus examination did not show any abnormalities. Visual acuity improved to 10/10 and visual field defect regressed in the following 2 weeks. Three years later, the patient returned with acute visual loss in the right eye. Visual acuities were 2/10 on the right and 10/10 on the left. Right optic disc had blurred margins with mild oedema. The tests revealed methylenetetrahydrofolate reductase A1298C mutation with positive lupus anticoagulant and hyperhomocysteinaemia. Enoxaparin was initialised with vitamin B12 supplementation. Complete visual recovery occurred in the following 3 weeks in both eyes. Thrombophilic screening seems to be important in the treatment and prevention of an attack in the second eye of patients with non-arteritic anterior ischaemic optic neuropathy.

Topics: Adult; Humans; Male; Optic Nerve Diseases; Thrombophilia; Visual Acuity; Vitamin B 12

To estimate the prevalence of optic neuropathy (ON) among prisoners in a provincial prison in Papua New Guinea, and to explore risk factors for this condition among this population.. Cross-sectional observation study of 148 male prisoners aged ≥18 years using an interview-based questionnaire, assessment of visual and nervous system function, ocular examination, and blood analysis (α-tocopherol, β-carotene, lutein, folate, homocysteine, holotranscobalamin II, riboflavin, selenium, thiamin, and vitamins A, B(12) and C). Likelihood of the presence of ON was based on ordered groups determined by weighted combination of optic nerve head appearance and visual dysfunction (acuity, field, color perception). Main outcome measures were prevalence and associations of ON.. Sample prevalence of clinical ON was 10.4% (95% confidence interval [CI], 6.2-16.8). No cases were found of unexplained non-visual nervous system dysfunction, including peripheral neuropathy. Increasing age (p = 0.001), length of current (p = 0.002) and lifetime (p = 0.03) incarceration, and duration of smoking by current smokers (p = 0.001) were associated with increased ON likelihood. However, when age-controlled, the smoking duration association was not maintained (p = 0.6). Prisoners were folate deficient. Adjusting for age and duration of current incarceration, whole blood (p = 0.02) and red blood cell (p = 0.04) folate concentrations were inversely associated with ON likelihood. No association was found for any other assessed demographic, lifestyle or biochemical measure.. A cluster of ON associated with folate deficiency has been identified. Recommendations for dietary change and micronutrient supplementation have been made.

Topics: Adult; alpha-Tocopherol; beta Carotene; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Humans; Lutein; Male; Optic Nerve Diseases; Papua New Guinea; Prevalence; Prisoners; Risk Factors; Selenium; Surveys and Questionnaires; Vision Disorders; Vitamin A; Vitamin B 12

Bilateral optic neuropathy in Dar-es-Salaam, Tanzania was first reported as an epidemic in 1988. Now argued to be endemic in 2010, the aetiology remains unclear. The authors investigated the hypothesis that low folate and vitamin B₁₂ status are associated with optic neuropathy, and also sought to investigate whether mercury, commonly used drugs, dietary factors and indoor pollution may also be risk factors.. 57 cases and 102 controls were recruited from two tertiary referral centres in Dar-es-Salaam. Data were collected on demographic characteristics, diet, medication history and HIV status. Folate and vitamin B₁₂ (holo-transcobalamin) were measured in stored serum samples. Exposure to mercury was assessed from concentrations in random urine samples.. Cooking indoors more than twice per week (OR 54.48 (95% CI 9.30 to 319.10)) and indoor use of charcoal or firewood (OR 21.20 (95% CI 2.51 to 179.36)) increased the risk of optic neuropathy. Risk was reduced in those with a higher folate status (highest versus lowest quartile OR=0.11 (95% CI 0.02 to 0.51)) and higher protein intakes (OR=0.84 (95% CI 0.72 to 0.96). No association was found with mercury exposure or any common drug or food commodity.. This study presents the first direct evidence of low folate status and indoor pollution in the aetiology of endemic bilateral optic neuropathy in Tanzania.

Topics: Adolescent; Adult; Air Pollution, Indoor; Child; Cooking; Environmental Exposure; Folic Acid; Folic Acid Deficiency; Humans; Nutrition Assessment; Optic Nerve Diseases; Risk Factors; Tanzania; Visual Acuity; Vitamin B 12; Young Adult

Optic neuropathy is a rare but recognised complication of vitamin B12 deficiency, which may proceed to visual failure if not diagnosed early enough. Clues to the possible diagnosis include a history of, or risk factors for, pernicious anaemia, or previous resective gastrointestinal surgery.

Topics: Adult; Anemia, Pernicious; Female; Humans; Optic Nerve Diseases; Risk Factors; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Clioquinol is a hydroxyquinoline antibiotic that has been associated with severe side-effects in the CNS. The syndrome caused by clioquinol treatment, subacute myelo-optic neuropathy (SMON), is considered as one of the worst drug disasters of this century. The precise biochemical mechanism behind SMON is not fully understood. Clioquinol can form strong lipophilic chelates with divalent cations and therefore it has been speculated that the drug may disturb the retention of vitamin B(12) through chelation of Co(2+). In the present study, the tissue distribution and uptake capacity of [57Co]cyanocobalamin were estimated in mice treated with clioquinol or saline. The concentrations of some trace metals were also determined in brain tissue. Accumulation of vitamin B(12) in the brain and its concentration in blood were decreased by clioquinol treatment. The mean concentrations of several trace metals were also lowered in the brain while the concentration of cobalt in the brain was not affected, suggesting that clioquinol does not bind to the cobalt in vitamin B(12). Moreover, a significant decrease in the levels of S-adenosylmethionine (SAM) was observed in the brain after clioquinol treatment. This may be a consequence of decreased vitamin B(12) levels. From these results, it can be concluded that chronic treatment with clioquinol may alter the tissue homeostasis of vitamin B(12) in the brain.

Topics: Amebicides; Animals; Brain; Clioquinol; Male; Metals; Mice; Mice, Inbred Strains; Optic Nerve Diseases; S-Adenosylhomocysteine; S-Adenosylmethionine; Trace Elements; Vitamin B 12

The concentrations of vitamin B12 in the sera from 77 patients diagnosed as suffering from the toxic optic neuropathy associated with tobacco smoking were compared with control levels and with serum folic acid concentrations from the same patients. Of these, 17 patients had associated pernicious anaemia. Serum vitamin B12 levels were significantly lower, whereas the folic acid concentrations showed great variation. Folic acid levels in the serum tended to be high when the vitamin B12 level was low (r = 0.29). The results suggest that the role of folic acid in the genesis of the optic neuropathy is not marked. However persistently low levels of folic acid occurred in one subject and significant clinical improvement resulted only from specific therapy.

Topics: Adult; Aged; Anemia, Pernicious; Female; Folic Acid; Folic Acid Deficiency; Humans; Hydroxocobalamin; Male; Middle Aged; Optic Nerve Diseases; Smoking; Visual Acuity; Vitamin B 12; Vitamin B 12 Deficiency

A 17-year-old boy with vitamin B12 deficiency that occurred after a small bowel resection developed bilateral centrocecal scotomas during folic acid therapy and improved on therapy including vitamin B complex.

Topics: Adolescent; Folic Acid; Gangrene; Humans; Hydroxocobalamin; Infectious Mononucleosis; Intestine, Small; Malabsorption Syndromes; Male; Optic Nerve Diseases; Postoperative Complications; Scotoma; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Humans; Neuritis; Optic Nerve; Optic Nerve Diseases; Optic Neuritis; Vitamin B 12

Topics: Alcoholic Neuropathy; Alcoholism; Humans; Neuritis; Nicotiana; Optic Nerve; Optic Nerve Diseases; Smoking; Vitamin B 12; Vitamin B Complex

Topics: Disease; Eye; Humans; Optic Nerve; Optic Nerve Diseases; Vitamin B 12