Acute Psychosis in a Patient With Vitamin B 12 Deficiency and Coincident Cervical Stenosis

Abstract

Received November 6, 2001; accepted November 27, 2001. From the Department of Psychiatry and Behavioral Sciences, Emory University Hospital, Atlanta, Georgia; and Emory University School of Medicine. Address correspondence and reprint requests to Dr. Herr, Department of Psychiatry and Behavioral Sciences, 1365 Clifton Road NE, Suite B6100, Atlanta, GA 30322. Deficiency of vitamin B12 has a well-established association with a wide variety of neurologic and psychiatric presentations. Subacute combined degeneration of the spinal cord, a term coined by Russell et al. in 1900,1 refers to the classic neuropathy associated with pernicious anemia, a disorder caused by vitamin B12 deficiency. Typical features of this condition include symmetric paresthesias of the upper and lower limbs, with concomitant loss of vibratory sense and proprioception. Progression of the disease leads to corticospinal tract involvement with consequent weakness of voluntary muscles, spasticity, abnormal tendon reflexes, and ataxic or spastic gait.2,3 The psychiatric presentation of vitamin B12 deficiency is protean and includes slowed mentation, delirium, affective disorder, personality change, and acute or chronic psychosis.4 Although vitamin B12 deficiency is generally categorized as a reversible dementia, this classification has been debated.4,5 We present a patient with acute psychosis whose neurologic complaints were initially attributed solely to severe cervical stenosis, as documented by magnetic resonance imaging. This case demonstrates the importance of considering vitamin B12 deficiency in individuals who present with symptoms that may suggest not only a surgically correctable defect but also an unrelated metabolic disorder, such as vitamin B12 deficiency. Case Report