B12 Deficiency

Sites

  • Affect peripheral nerves
  • Affects dorsal and lateral columns of spinal cord--> myleopathy

Etiology

  • S/p gastrectomy
  • Crohn's dz
  • Gastric by-pass
  • Ileal resection
  • Pernicious anemia
  • Rarely diet related

Symptoms

  • Gait problems
  • Fatigue
  • Sob w/anemia
  • Confusion
  • Progressive numbness
  • Paresthesia which can be painful
  • Affects legs more common then arms
  • Symmetric weakness

Physical Exam Findings

  • Ataxia
  • Hyper-reflexia
  • + romberg
  • Tachycardia if sig anemia
  • Tongue can be smooth and swollen if severe
  • Diminished peripheral sensation
  • Impaired proprioception
  • Impaired vibration sense
  • Symetric weakness

Tests