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Neurologic and evoked potential abnormalities in subtle cobalamin deficiency states, including deficiency without anemia and with normal absorption of free cobalamin.
- Source :
-
Archives of neurology [Arch Neurol] 1990 Sep; Vol. 47 (9), pp. 1008-12. - Publication Year :
- 1990
-
Abstract
- The meaning of a low serum cobalamin level when the classic findings of pernicious anemia are lacking is undergoing reevaluation. We therefore studied the neurologic status of 11 patients who had low cobalamin levels without definite hematologic evidence of deficiency. Neurologic evaluation included pattern-shift visual and median and posterior tibial nerve somatosensory evoked potentials. None of the patients had megaloblastic changes in the blood or bone marrow, although 7 of the 11 had subtle cellular cobalamin disturbances demonstrated by an abnormal deoxyuridine suppression test result. Seven patients had normal Schilling test results and 2 had borderline results; however, 2 of the 5 patients tested further had food-cobalamin malabsorption, while a third had prepernicious anemia. The patients displayed a variety of neurologic problems, including dementia, depression, myelopathy, neuropathy, and seizure disorder; 1 patient was neurologically normal by clinical criteria. Evoked potential abnormalities were demonstrable in 8 of the 9 patients with subtle cobalamin deficiency, and in at least 5 cases the disturbance was central. In contrast, both patients whose low serum cobalamin levels were found on evaluation to be spurious had normal evoked potentials. Evoked potential abnormalities improved in the one patient retested after cobalamin therapy. These findings demonstrate that neurologic deficits occur not only in classic cobalamin deficiency but also in subtle or atypical cobalamin deficiency states in which anemia is absent and Schilling test results are normal. Electrophysiologic evidence of neurologic impairment is often present, even in patients without obvious clinical neurologic abnormalities.
- Subjects :
- Absorption
Adult
Aged
Anemia, Megaloblastic complications
Anemia, Pernicious complications
Anemia, Pernicious metabolism
Female
Humans
Intestinal Absorption
Male
Middle Aged
Nervous System Diseases complications
Nervous System Diseases metabolism
Vitamin B 12 metabolism
Vitamin B 12 Deficiency complications
Evoked Potentials
Nervous System Diseases diagnosis
Vitamin B 12 Deficiency diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 0003-9942
- Volume :
- 47
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Archives of neurology
- Publication Type :
- Academic Journal
- Accession number :
- 2396929
- Full Text :
- https://doi.org/10.1001/archneur.1990.00530090082017