VITAMIN B12 DEFICIENCY;

FREQUENCY OF NEUROLOGICAL MANIFESTATIONS IN QUETTA.

Abstract

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.