Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency
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Vitamin B12 causes a wide spectrum of gastrointestinal and neuropsychiatric manifestations. From a neurological standpoint, the peripheral nerves, spinal cord and optima nerves are affected by B12 deficiency. Damage to the spinal cord, however, tends to be affected early and often exclusively, according to certain reports.
A case study published by Science Alert highlights the breadth of symptoms associated with shortages in vitamin B12.
In 2012, the platform described the case of a 61-year-old man who was admitted to the Emergency Department (ED) after suffering an onslaught of symptoms.
The patient reported, “trouble to walk independently, suffering from weakness and long history of dyspepsia that had worsened in the last four weeks”.
The senior reportedly suffered from mild impairment of cognitive functions, motor strength was normal and several of his reflexes were absent.
The report continued: “All blood tests were normal except haemoglobin concentration which showed mild anaemia.”
Loss of deep tendon reflexes is a widely recognised complication of vitamin B12 deficiency associated with nerve damage, known as peripheral neuropathy.
Paraesthesia is considered the most common primary complaint in neurological patients, accounting for more than 70 percent of the neurological symptoms seen in B12 deficiency.
Paraesthesia is a term closely tied to peripheral neuropathy which indicates a burning or prickling sensation in the hands, arms, legs, or feet.
In the patient’s case, paraesthesia manifested in the limbs, comprising his ability to move around freely.
Due to trouble walking, the 61-year-old was referred for surgery based on mild bulging disks seen during an MRI scan.
The patient’s report continued: “He mentioned a long history of dyspepsia and became confined to his home because of gait disturbance.
“Further examinations before the surgery due to the approach to anaemia showed severely decreased serum vitamin B12 levels.”
Fortunately, the patient’s symptoms improved after treatment with intramuscular vitamin B12 injections.
If the underlying cause of peripheral neuropathy isn’t treated early or adequately, however, serious complications can ensue.
These include foot ulcers that become infected due to loss of feeling, which may require amputation.
The report concluded: “Being a very commonly seen disorder in the general population, B12 deficiency should be in mind as a probable diagnosis in patients with peripheral neuropathy and no clear underlying cause presenting to the emergency department.
“Therefore, simple screening with CBC might decrease neurologic complications, morbidity, and inappropriate workups through early diagnosis and treatment. “
How does B12 deficiency injure the spinal cord?
After a spinal cord injury due to a lack of vitamin B12, communication between the brain and the rest of the body falters.
This can detrimentally affect a person’s sensory, motor and reflex messages which are signalled through the spinal cord.
Because the patient in question was not vegetarian, his condition was put down to malabsorption of vitamin B12 due to “pernicious anaemia or achlorhydria due to the proton pump inhibitors”.
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