Abstract
Long-standing vitamin B12 deficiency can lead to neurological manifestations such as optic atrophy and subacute combined degeneration of the cord without causing significant anemia. In addition, folic acid supplementation could mask the hematological manifestations of vitamin B12 deficiency and delay the presentation of neurological manifestations We present a case of a 32-year-old vegan woman on long-term sodium valproate and folic acid treatment presenting with progressive weakness of bilateral lower limbs for three months and reduced vision in both eyes for two weeks duration. Further evaluation revealed optic atrophy, combined degeneration of the spinal cord, macrocytosis, thrombocytopenia, and severely deficient serum B12 levels. With B12 replacement therapy, the patient’s overall wellbeing improved.
Highlights
B12 deficiency is known to cause neurological and psychiatric manifestations.1The classic neurological finding in B12 deficiency is described as subacute combined degeneration of dorsal and lateral columns of the spinal cord.[1]
Neuropsychiatric manifestations of B12 deficiency are identified in the absence of anemia or macrocytosis[2]
Megaloblastic anemia is a major manifestation of vitamin B12 deficiency
Summary
B12 deficiency is known to cause neurological and psychiatric manifestations.1The classic neurological finding in B12 deficiency is described as subacute combined degeneration of dorsal and lateral columns of the spinal cord.[1]. Case Report Our patient was a 32-year-old unmarried woman who has been working in a garment factory She had been taking sodium valproate 200mg three times a day and folic acid 5mg daily since 11 years of age for epilepsy. She noted pins and needles in her both feet which started 3 months ago She has experienced progressive worsening of difficulty in walking which stopped her from going to work. All the muscle groups of the right upper limb showed wasting, hypertonia, and hyperreflexia with normal sensation. Her peripheral blood revealed; white blood cell count.
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