• Irfana Hassan Bolan Medical College, Quetta
  • Bhagwan Das Liaquat University of Medical & Health Sciences, Jamshoro
  • Santosh Kumar LUMHS.
  • Ghulam Haider Khalid JPMC, Karachi
  • Abdul Manan Junejo JPMC, Karachi
  • Noor-Un- Nisa Bolan Medical College, Quetta
  • Rahul Kumar LUMHS, Jamshoro



Megaloblastic Anemia,, Serum B12,, Dementia,, Mcv.


Objectives: To determine the frequency of neurological manifestations of vitamin B12
deficiency and to observe the reversibility of the symptoms after the therapy. Study Design: Descriptive
study. Study Design: Descriptive study. Setting: Medicine Department of Bolan Medical Complex Hospital
Quetta. Period: One year that is from January 2012 to December 2012. Methodology: 46 patients presented
to various OPDS of B.M.C.H.. The inclusion criteria for the patients to be studied were: Anemia, Neurological
complaints. Results: Out of 46 patients 26(56%) were males and 20(43%) were the females with a mean
age of (40) years.32 (69%) belonged to the rural areas. 45(97%) had mixed diets whereas only one 1(2.1%)
young non Muslim was found to be pure vegetarian.32 (69%) patients presented with hematological as
well as neurological complaints. 23(30%) had pancytopenia and 9(19.5%) had bicytopenia. 14(30%)
presented with neurological complaints only as sacd 6 (13%), ataxia 8 (17%), sensorimotor neuropathies
36 (78%) and dementia 2 (4.3%). In signs glossitis was found in 6(13%), jaundice in 22 (47%), pallor in
32 (69%) proximal myopathy in 12 (26%) out of which 6 (13%) had shoulder girdle and 8 (17%) pelvic
girdle myopathy. Impaired position sense was found in 18 (39%) patients and vibration sense in 21(45%)
patients. other signs were pigmentation 2(4.3%) hypotonia in 6(13%) Spasticity in 2(4.3%) and Upgoing
plantars in 6(13%) patients. Lhermittes sign could be elicited in only 2(4.3%) patients Optic neuritis and
optic atrophy was found in 4(8.6%) patients who came with paraplegia and marked anemia. Rhombergs
sign was positive in 8(17.3%) who came with clumsiness of gait. Hemoglobin (Hb %) was found to be low
in 32(69%) with a mean of 7.2gm%.pancytopenia (anemia+leucopenia+thrombocytopenia) was found in
23(50%) of patients whereas bicytopenia was found only in 9(19.5%) of patients. Hypersegmented W.B.C
were very carefully looked for and were found in 20(43%) of cases. ovalomegaloblasts were found in 32
(69%) of cases .both findings of ovalomegaloblasts and hypersegmented w.b.cs were found in 20 (43%).
in the rest 14 (30%) the blood investigations were found to be normal. The next investigation in all patients
was serum B12 estimation, It was found that levels below 200pg/ml were found in 95% cases where only
2(4.3%) patients came with levels slightly above 205pg/ml and 210pg/ml. the response to therapy was
recorded as reversible and irreversible. the irreversible features were sacd in 6 (13%), optic atrophy in
2 (4.3%), and dementia in 2 (4.3%) patients. the partially reversible features were myelopathy 10 (21%)
numbness and paraesthesias 30 (65%) optic neuritis inn 2 (4.3%) patients were assessed on a duration
of 24 weeks. partially reversible features were ataxia, in 6 (13%) patients myelopathy in 2 (4.3%) patients
dementia in 2 (4.3%) patients and paraesthesias and numbness in 6 (13%) patients over a period of 24
weeks. Conclusion: It is concluded from my study that the neuropsychiatric manifestations of vitamin B12
deficiency are common among the elderly age group, either with or with out the evidence of anemia.

Author Biographies

Irfana Hassan, Bolan Medical College, Quetta

FCPS Medicine
FCPS Nephrology
Assistant Professor Medicine

Bhagwan Das, Liaquat University of Medical & Health Sciences, Jamshoro

Senior Registrar Nephrology

Santosh Kumar, LUMHS.

FCPS (Medicine)
Assistant Professor of Medicine

Ghulam Haider Khalid, JPMC, Karachi

FCPS (Urology)
Assistant Professor

Abdul Manan Junejo, JPMC, Karachi

FCPS (Nephrology)

Noor-Un- Nisa, Bolan Medical College, Quetta

FCPS (Nephrology)
Assistant Professor

Rahul Kumar, LUMHS, Jamshoro

BDS 3rd Student