好色先生

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Abstract Details

Vitamin B12 deficiency presenting with acute psychosis
General Neurology
P3 - Poster Session 3 (5:30 PM-6:30 PM)
4-051
 To describe a case of vitamin B12 deficiency with acute psychosis in a 27-year-old patient with sub-acute combined degeneration of the cord (SACD)
Though an uncommon complication, acute psychosis in vitamin B12 deficiency has been reported and was initially coined as “megaloblastic madness”.  Presenting symptoms include fatigue, apathy, irritability, cognitive slowing, and forgetfulness. It can occur with or without other features of vitamin B12 deficiency such as SACD
Case report
A 27-year-old HIV-negative man presented to a neurology clinic in Zambia with progressive difficulty walking over one month. Six months prior, he developed an anal fissure with hematochezia and severe anemia (hemoglobin 4) requiring surgical correction to stop bleeding. A month before presentation, he became increasingly withdrawn and was diagnosed with depression in a psychiatric clinic. On presentation, he had a 5 day history of visual and auditory hallucinations, progressive paranoia and had stopped walking. Examination revealed a thin patient responding to auditory and verbal hallucinations who accused the examiner of trying to harm him. He also had a spastic tetraparesis, hyperreflexia with clonus, a palpable bladder, and was unable to walk. He had anemia (Hb – 10, MCV – 106) and vitamin B12 <60pmol/l. He had normal cerebrospinal fluid (CSF) studies, Rapid Plasma Reagin (RPR) and MRI scan of his brain and spine. He was supplemented with injectable vitamin B12. After two months, his mental status had nearly returned to normal although his tetraparesis did not improve. After six months, his strength had markedly improved although he remained non-ambulatory
While subacute combined degeneration of the cord and megaloblastic anemia are a common presentation of vitamin B12 deficiency, physicians should be aware of acute pyschosis as a rare, but reversible complication
Authors/Disclosures
Stanley Zimba, MBBS (University Teaching Hospital)
PRESENTER 		Dr. Zimba has nothing to disclose.
Deanna Saylor, MD, MHS (Johns Hopkins Hospital) Dr. Saylor has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from 好色先生. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and 好色先生al Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.