Abstract
Vitamin B12 deficiency is associated with a wide spectrum of neuro-psychiatric manifestations. We report a case of a 44 year old female patient referred to the haematology unit with vitamin B12 deficiency presenting as an acute confusional state or delirium. Total resolution of the psychiatric symptoms occurred following parenteral vitamin B12 replacement therapy. This case report highlights one of the neuro-psychiatric presentations of vitamin B12 deficiency in a previously healthy individual.
Highlights
Vitamin B12 deficiency has been highly linked to several psychiatric disorders like impaired memory, irritability, depression, dementia, delirium, schizophrenia and psychosis[1]
A recent study done in Uganda demonstrated prevalence of low vitamin B12 levels of 28.6% among 280 psychiatric patients admitted at the main psychiatric referral hospital[7]
She did not have any history of chronic PPI or metformin use or any clinical evidence suggestive of auto immune conditions and malabsorption syndrome. Both parenteral and oral vitamin B12 replacement therapies have been demonstrated to have equivalent effectiveness in achieving the desirable haematological and neurological remissions regardless of the aetiology of vitamin B12 deficiency . 13-15 Intra muscular vitamin B12 treatment was preferred in this patient because it is cheaper in Uganda and to improve on compliance
Summary
Vitamin B12 deficiency has been highly linked to several psychiatric disorders like impaired memory, irritability, depression, dementia, delirium, schizophrenia and psychosis[1]. A recent study done in Uganda demonstrated prevalence of low vitamin B12 levels of 28.6% among 280 psychiatric patients admitted at the main psychiatric referral hospital[7] One percent of these patients had delirium as the primary psychiatric diagnosis. Case report A 44 year old HIV sero negative lady was referred to the haematology unit from a rural hospital mainly for blood transfusion due to severe anemia She presented with a three weeks history of uncoordinated speech, aggressiveness, reduced sleep, wandering away from her home, poor concentration and visual hallucinations mainly worsening at night. The above symptoms were preceded by a three months history of generalised body weakness, intense paraesthesias of the lower limbs, palpitations and exertional dyspnea She did not have any past psychiatric history, history suggestive of diabetes mellitus, auto immune diseases or any past gastric or ileal surgery. The patient was fully counselled about her condition and discharged later
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