Document Detail

Vitamin B12 deficiency in spinal cord injury: a retrospective study.
MedLine Citation:
PMID:  12828286     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/OBJECTIVE: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI). This retrospective study describes vitamin B12 deficiency in SCI. METHODS: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B12 testing over the last 10 years. RESULTS: Probable vitamin B12 deficiency was noted in 16 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/mL), whereas 4 patients had low-normal vitamin B12 levels (< 300 pg/mL) with neurologic and/or psychiatric symptoms that improved following vitamin B12 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 16 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 16 SCI patients presented with depression and fatigue, 2 had worsening pain, 2 had worsening upper limb weakness, and 2 had memory decline. Of the 12 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B12, macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anemia was identified in 7 of the 16 patients and macrocytic red blood cells were found in 3 of the 16 patients. Only 1 of the 16 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency (ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit), including reversal of anemia (5 patients), improved gait (4 patients), improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients), strength gain (1 patient), and reduced numbness (1 patient). CONCLUSION: It is recommended that physicians consider vitamin B12 deficiency in their patients with SCI, particularly in those with neurologic and/or psychiatric symptoms. These symptoms often are reversible if treatment is initiated early.
Wannapha Petchkrua; James W Little; Stephen P Burns; Steven A Stiens; Jennifer J James
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The journal of spinal cord medicine     Volume:  26     ISSN:  1079-0268     ISO Abbreviation:  J Spinal Cord Med     Publication Date:  2003  
Date Detail:
Created Date:  2003-06-27     Completed Date:  2003-08-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9504452     Medline TA:  J Spinal Cord Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  116-21     Citation Subset:  IM    
Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA.
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MeSH Terms
Aged, 80 and over
Diagnosis, Differential
Middle Aged
Outcome Assessment (Health Care)
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Spinal Cord Injuries / complications*,  physiopathology,  therapy
Vitamin B 12 Deficiency / diagnosis,  etiology*,  physiopathology
Comment In:
J Spinal Cord Med. 2003 Summer;26(2):122-3   [PMID:  12828287 ]

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