vitamin-b-12 and Reflex--Abnormal

Topics: Achilles Tendon; Aldehyde Reductase; Antidepressive Agents, Tricyclic; Diabetic Neuropathies; Diagnosis, Differential; Electrodiagnosis; Enzyme Inhibitors; Excitatory Amino Acid Antagonists; Humans; Hypoglycemic Agents; Ketamine; Neural Conduction; Reflex, Abnormal; Vibration; Vitamin B 12

Approximately 15% of people aged more than 60 years old have a cobalamin (vitamin B12) deficiency, mainly in relation with food-cobalamin malabsorption (FCM). To date, no study has documented this disorder in the elderly. There is also little information on clinical consequences.. We studied 92 elderly patients with well-established FCM who were extracted from an observational cohort study (1995-2004) of 172 consecutive elderly patients with documented cobalamin deficiency.. The median patient age was 76 +/- 8 years; 60 patients were women. The most common clinical manifestations were neurologic or psychologic: mild sensory polyneuropathy (44.6%), confusion or impaired mental functioning (22.8%), and physical asthenia (20.7%). Hematologic abnormalities were reported in at least one third of the patients: anemia (21%), leukopenia (10.9%), thrombopenia (8.7%), and pancytopenia (6.5%). All patients had low serum vitamin B12 levels (<200 pg/mL), with a mean value (+/- standard deviation) of 131 +/- 38 pg/mL and total serum homocysteine level of 22.1 +/- 9.3 micromol/L. The mean hemoglobin level was 10.9 +/- 2.5 g/dL and the mean erythrocyte cell volume 95.7 +/- 12.7 fL. Correction of the serum vitamin B12 levels and hematologic abnormalities was achieved equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin.. This study suggests that in elderly patients, FCM may be associated with significant neurologic, psychologic, and hematologic abnormalities, which seem to respond equally well to either oral or parenteral vitamin B12 therapy.

Topics: Aged; Aged, 80 and over; Asthenia; Cognition Disorders; Cohort Studies; Confusion; Edema; Erythrocyte Indices; Female; Follow-Up Studies; Gastritis, Atrophic; Hematologic Diseases; Hemoglobins; Homocysteine; Humans; Jaundice; Malabsorption Syndromes; Male; Paresthesia; Polyneuropathies; Reflex, Abnormal; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aged, 80 and over; Electromyography; Humans; Male; Middle Aged; Myoclonus; Paresthesia; Pressure; Reflex, Abnormal; Thoracic Vertebrae; Vitamin B 12; Vitamin B 12 Deficiency

On the present study the authors evaluate the utility of electrophysiologic examination in uraemic polyneuropathy. A group of 19 uraemic patients in chronic dialysis underwent the Blink reflex and BAEPSs study to evaluate the alterations of nervous pathways. The results obtained were compared with those of a group of 10 healthy patients comparable for age and sex. The electrophysiologic parameters have been statistically compared with the plasma levels of vit. B12. folic acid, PTH and beta-2-microglobulin. The results show a significant difference of uremic patients compared with the healthy ones for the Blink reflex (ipsilateral and contralateral R2 responses). Also BAEPSs show significant alterations in the uraemic group (latencies of the III, V components). A statistically significantly inverse correlation is present between folic acid values and blink reflex R1 and R2 responses. Therefore our study shows the existence of a combined degeneration of central and peripheral nervous pathways in chronic uraemic patients. We believe that the decrease in folic acid concentration found in our study may be one of the causes of the beginning and then of the worsening of neurologic damage.

Topics: Adult; Aged; beta 2-Microglobulin; Blinking; Disease Progression; Evoked Potentials, Auditory, Brain Stem; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Parathyroid Hormone; Peripheral Nervous System Diseases; Reflex, Abnormal; Renal Dialysis; Uremia; Vitamin B 12

We reviewed 153 episodes of cobalamin deficiency involving the nervous system that occurred in 143 patients seen over a recent 17-year period at 2 New York City hospitals. Pernicious anemia was the most common underlying cause of the deficiency. Neurologic complaints, most commonly paresthesias or ataxia, were the first symptoms of Cbl deficiency in most episodes. The median duration of symptoms before diagnosis and treatment with vitamin B12 was 4 months, although long delays in diagnosis occurred in some patients. Diminished vibratory sensation and proprioception in the lower extremities were the most common objective findings. A wide variety of neurologic symptoms and signs were encountered, however, including ataxia, loss of cutaneous sensation, muscle weakness, diminished or hyperactive reflexes, spasticity, urinary or fecal incontinence, orthostatic hypotension, loss of vision, dementia, psychoses, and disturbances of mood. Multiple neurologic syndromes were often seen in a single patient. In 42 (27.4%) of the 153 episodes, the hematocrit was normal, and in 31 (23.0%), the mean corpuscular volume was normal. Neutropenia and thrombocytopenia were unusual even in anemic patients. In nonanemic patients in whom diagnosis was delayed, neurologic progression frequently occurred although the hematocrit remained normal. In 27 episodes, the serum cobalamin concentration was only moderately decreased (in the range of 100-200 pg/ml) and in 2 the serum level was normal. Neurologic impairment, as assessed by a quantitative severity score, was judged to be mild in 99 episodes, moderate in 39 and severe in 15. Severity of neurologic dysfunction before treatment was clearly related to the duration of symptoms prior to diagnosis. In addition, the hematocrit correlated significantly with severity, independent of the longer duration of symptoms in nonanemic patients. Four patients experienced transient neurologic exacerbations soon after beginning treatment with cyanocobalamin, with subsequent recovery. Followup evaluation was adequate to assess the neurologic response to vitamin B12 therapy in 121 episodes. All patients responded, and in 57 (47.1%), recovery was complete, with no remaining symptoms or findings on examination. The severity score was reduced by 50% or greater after treatment in 91% of the episodes. Residual long-term moderate or severe neurologic disability was noted following only 7 (6.3%) episodes. The extent of neurologic involvement after treatment

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Pernicious; Ataxia; Evoked Potentials, Somatosensory; Humans; Memory Disorders; Mental Disorders; Middle Aged; Nervous System Diseases; Paresthesia; Peripheral Nervous System Diseases; Reflex, Abnormal; Regression Analysis; Sensation; Spinal Cord Diseases; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Alcoholism; Folic Acid; Humans; Hypesthesia; Muscle Cramp; Neural Conduction; Polyneuropathies; Reflex, Abnormal; Sensation; Thiamine; Vitamin B 12

In a general medical hospital population the neurological status of 24 patients with severe folate deficiency was compared with that of a control group of 21 patients with normal serum folate. A significant increase of organic brain syndrome and pyramidal tract damage was found in the folate-deficient group. These findings were independent of the degree of anaemia or the presence of alcoholism. These data are consistent with the view that severe folate deficiency may cause neurological deficits.

Topics: Alcoholism; Anemia; Brain Diseases; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Nervous System Diseases; Pyramidal Tracts; Reflex, Abnormal; Vitamin B 12

Topics: Action Potentials; Anemia, Pernicious; Electrodiagnosis; Median Nerve; Neural Conduction; Neurologic Manifestations; Reflex, Abnormal; Vitamin B 12

Topics: Adolescent; Adult; Age Factors; Aged; Ataxia; Child; Child, Preschool; Cyanides; Deafness; Diet; Electromyography; Female; Folic Acid; Gait; Glucose Tolerance Test; Humans; Infant; Infant, Newborn; Leg; Male; Middle Aged; Motor Neurons; Muscles; Nervous System Diseases; Nigeria; Nutrition Disorders; Reflex, Abnormal; Riboflavin Deficiency; Sensation; Sex Factors; Thiocyanates; Vision Disorders; Vitamin B 12

Topics: Cerebral Palsy; Child; Clinical Laboratory Techniques; Down Syndrome; Electrocardiography; Electrophysiology; Humans; Hyperthyroidism; Hypothyroidism; Infant; Infant, Newborn; Meningitis; Physiology; Reflex; Reflex, Abnormal; Triiodothyronine; Vitamin B 12