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Neurological Manifestations Of Vitamin B12 (Coblamin) Deficiency with a Re-appraisal of its Etiology

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We undertook a study 25 patients, all clinically suspected to have vitamin B12 deficiency; they were investigated hematologically, biochemically, & by gastric biopsy and MRI. Most of the patients were more than 40 years of age, were either vegetarian or non-vegetarian; 21 patients were belonging to the middle-income group. The total number of males in the study was 22 and there were three females. The clinical features of vitamin B12 deficiency are described. Clinical evidence of pyramidal tract involvement was found in six patients (24%). MRI confirmed cord involvement in 12 of the 17 patients (70.5%): follow up MRI of two patients showed marked reductions in signals after one year of treatment. These patients showed improvement after receiving injectable vitamin b12. Nerve conduction studies (N.C.V) showed evidence of neuropathy in fifteen of eighteen (83%) patients. Gastric biopsy was abnormal in all except one in the 20 patients in whom it was conducted. Anti intrinsic factor blocking antibodies (AIFBA) were elevated in 11/24 (45.8%) and anti parietal cell antibodies (APCAB) were elevated in 19/24 patients (79%). The possible etiological factors responsible for vitamin B12 deficiency are age and pernicious anemia. As concluded in this study, diet was not found to be a contributory factor in the causation of cobalamin deficiency. We conclude that pernicious anemia is probably an important etiological factor as a cause of vitamin B12 deficiency in Indians. The male predominance is intriguing.


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