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Vitamin B12 deficiency causes a variety of symptoms in the hematologic, gastrointestinal tract, and neurologic deficit. We report a rare case of progressive gait disturbance, bradykinesia and dysarthria which was that vitamin B12 deficiency was diagnosed as the cause, and symptoms improved after intramuscular cobalamin treatment. Vitamin B12, homocysteine, and methylmalonic acid tests are recommended for patients with progressive gait disturbance, even in the absence of obvious anemia symptoms.

Decrease in the activity of methylenetetrahydrofolate reductase (MTHFR) increases the level of homocysteine. MTHFR C677T gene polymorphism has been reported as a well-known cause of elevated homocysteine level associated with cerebral venous sinus thrombosis (CVST). A 34-year-old male was admitted with severe headache after generalized seizure. Brain magnetic resonance venography showed thrombus in superior sagittal sinus. In the investigation of risk factors, a slight increase in homocysteine caused by MTHFR C677T heterozygous mutation is presumed to be the cause of CVST.

A 87-year-old woman presented with right hemiparesis and dysarthria. She had received the mRNA-BNT162b2 (Pfizer–BioNTech) 3 days ago. Initial blood and imaging test showed very low levels of platelets (20,000/μl) and acute MCA territorial embolic infarction with severe M1 stenosis. The several blood tests to find the cause including anti-platelet factor 4 antibody were unremarkable. The platelet count gradually increased up to 134,000/μl after treatment with intravenous steroid and anticoagulation. We reported cerebral infarction related to immune thrombocytopenia after receiving mRNA- coronavirus disease 2019 vaccine.