Dysarthria as an isolated neurological manifestation of Vitamin B12 deficiency: An unusual presentation

Abstract

Vitamin B12 (Vit. B12) is an important cofactor for the cellular metabolism and myelination. Vit. B12 deficiency can manifest as hematological, neurological, or gastrointestinal (GI) abnormalities. The following case had a unique manifestation of Vit. B12 deficiency in the form of dysarthria without any evidence of hematological involvement. From this case, we can infer that, in young patients with isolated neurological manifestation, Vit. B12 deficiency can always be a differential diagnosis. A 26-year-old female presented with complaints of fever, odynophagia, and dysarthria. She was vitally stable and had no neurological deficits. Her blood investigations showed leukopenia and thrombocytopenia. She was positive for dengue immunoglobulin M, her Vit. B12 levels were low, and her hemoglobin electrophoresis was suggestive of sickle-cell trait. She was subjected to an upper GI endoscopy which was suggestive of antral gastritis. Her magnetic resonance imaging findings were within normal limits. Upon intravenous supplementation of Vit. B12, her dysarthria resolved. From the clinical course and investigation, we consider that dysarthria is an isolated neurological manifestation of Vit. B12 deficiency.