Associates' Presentations
| Intro | Prev | Next | Last |
Dementia In Cobalamin Deficiency
M. Mouanoutoua, S. Varikuti, Department of Medicine, Sinai Samaritan Medical Center, Milwaukee, WI.
A 75 yo Afro-American male was brought to the hospital by a friend with a 6 months history of progressive weakness, falls, forgetfulness, dyspnea on exertion and bilateral lower extremity edema. Physical examination was significant for severe pallor, icterus, bilateral basilar rales and pitting edema. Neurological exam revealed ataxic gait, impaired position and vibration senses plus a mini-mental exam suggesting of a severe global dementia. Initial lab values revealed HGB 2.7 gm/dl, MCV 119, WBC 2900, and PLT 20K. Peripheral smear showed hypersegmented neutrophils. The serum LDH was 6443 and total bilirubin of 2.7. Further workup revealed a Cobalamin level of 64 pg/ml (211-911), Homocysteine 156 micromol/l (4.9-14.6), Methylmalonic acid 105 umol/l (<0.41), with normal folate and ferritin level. Anti-Intrinsic Factor was positive. A diagnosis of pernicious anemia was made. Patient was started on 1 mg Vit. B12 IM QD x 5 days, then 1 mg every week x 5 weeks as recommended by Teunisse et al. Surprisingly, the patient showed a drastic and full recovery from his initial neurological deficits, and a repeated mini-mental exam at 3 weeks post the initiation of Vit. B12 therapy showed a score of 30.
Vitamin B12 deficiency can lead to multiple neurologic findings including dementia. Three prospective studies did not show any improvement with Cobalamin therapy in patients who had dementia and low Vit. B12 level. One retrospective study, however, supported the existence of reversible dementia from Cobalamin deficiency. We speculate that the reversibility of dementia in this patient could be due to the initiation of treatment prior to irreversible insult that occurred to the brain.
| Intro | Prev | Next | Last |
What's New
Contact Information
Sharon Haase, MD, FACP
Chapter Governor
Kelly Lang
Chapter Support Staff
Ph: 414-755-6280
E-mail: lang@svinicki.com