Neurological manifestations of vitamin B12 deficiency in elderly patients: case report
DOI:
https://doi.org/10.52556/2587-3873.2025.2(104).35Keywords:
vitamin B12, megaloblastic anemia, funicularmyelosis, elderly, neurological disordersAbstract
Vitamin B12 deficiency is a frequently underestimated cause of megaloblastic anemia and neurological disorders, especially among the elderly. Clinical manifestations range from mild hematological changes to severe neuropsychiatric symptoms. Two clinical cases with severe mixed anemia and neurological manifestations are presented. The diagnosis was confirmed based on clinical and paraclinical investigations, requiring interdisciplinary involvement. Both patients had low serum vitamin B12 levels and clinical signs of funicular myelosis: paresthesia, gait disturbances, postural instability, muscle weakness, and cognitive impairment. Parenteral treatment with vitamin B12 was initiated, combined with iron and folic acid supplements, which led to improved hematological parameters and partial neurological recovery. Vitamin B12 deficiency in elderly patients can cause severe neurological syndromes, even in the absence of typical hematological changes. Early diagnosis and appropriate treatment are essential to prevent irreversible complications. Annual screening of elderly people and careful monitoring of patients with risk factors for malabsorption are recommended.
References
1. ALGHAMDI, A. Structural and functional brain changes associated with vitamin B12 deficiency using magnetic resonance imaging: A systematic review and meta-analysis. In: Current Medical Imaging, 2023. vol. 19, nr. 4, pp.312-326. https://doi.org/10.2174/1573405618666220516113758
2. AZZINI, E., RAGUZZINI, A., POLITO, A. A brief review on vitamin B12 deficiency looking at some case study reports in adults. In: International Journal of Molecular Sciences, 2021. 22(18), p.9694. https://doi.org/10.3390/ijms22189694
3. BALASUBRAMANIAN, S., J. et al. Neurological manifestations of vitamin B12 deficiency. In: International Journal of Neurology and Neurosurgery. 2019. https://doi.org/10.21088/ijnns.0975.0223.11119.3
4. ESPOSITO, G. et al. Pernicious anemia: The hematological presentation of a multifaceted disorder caused by cobalamin deficiency. In: Nutrients, 2022. 14(8), p.1672. https://doi.org/10.3390/nu14081672
5. GAO, Y., ZHANG, Y., WANG, L. The association of vitamin deficiency with depression risk in late life depression: a review. In: Frontiers in Nutrition, 2025. vol. 12, 1551375. https://doi.org/10.3389/fnut.2025.1551375
6. GREEN, R., MILLER, J.W. 2022. Vitamin B12 deficiency. LITWACK, G. (ed.). Vitamins and Hormones, vol. 119. Amsterdam: Academic Press, pp.405-439. https://doi.org/10.1016/bs.vh.2022.02.003
7. GRÖBER, U., KISTERS, K., SCHMIDT, J. Neuroenhancement with vitamin B12-underestimated neuro logical significance. In: Nutrients, 2013. vol. 5, nr. 12, pp.5031-5045. https://doi.org/10.3390/nu5125031
8. GUÉANT, J.L. et al. Causes and consequences of impaired methionine synthase activity in acquired and inherited disorders of vitamin B12 metabolism. In: Critical Reviews in Biochemistry and Molecular Biol ogy, 2021. 57(2), pp.133-155. https://doi.org/10.1080/10409238.2021.1979459
9. GUIEU, R., RUF, J., MOTTOLA, G. Hyperhomocysteinemia and cardiovascular diseases. In: Annales de Biologie Clinique (Paris), 2022. vol. 80, nr. 1, pp.7-14. https://doi.org/10.1684/abc.2021.1694
10. GWATHMEY, K.G., GROGAN, J. Nutritional neuropathies. In: Muscle & Nerve, 2020. vol. 62, pp.13-29. https://doi.org/10.1002/mus.26783
11. HEALTON, E.B., SAVAGE, D.G. Neurologic aspects of cobalamin deficiency. In: Medicine (Baltimore), 1991. vol. 70, pp.229-245.
https://doi.org/10.1097/00005792-199107000-00001
12. JATOI, S. et al. Low vitamin B12 levels: an underestimated cause of minimal cognitive impairment and dementia. In: Cureus, 2020. vol. 12, nr. 2, e6976. https://doi.org/10.7759/cureus.6976
13. KAYALI, S., GÖKCEBAY, D.G. Influence of vitamin B12 deficiency on autonomic nervous system activity in children. In: Iranian Journal of Pediatrics, 2019. 29(5). https://doi.org/10.5812/ijp.92634
14. LEVY, J. et al. Cardiovascular manifestations of intermediate and major hyperhomocysteinemia due to vitamin B12 and folate deficiency and/or inherited disorders of one-carbon metabolism: a 3.5-year retrospective cross-sectional study of consecutive patients. In: American Journal of Clinical Nutrition,2021. vol. 113, nr. 5, pp.1157-1167. https://doi.org/10.1093/ajcn/nqaa432
15. MATHEW, A.R. et al. Vitamin B12 deficiency and the nervous system: Beyond metabolic decompensation - Comparing biological models and gaining new insights into molecular and cellular mechanisms. In: International Journal of Molecular Sciences. 2024.,25(1), p.590. https://doi.org/10.3390/ijms25010590
16. McCOMBE, P.A., McLEOD, J.G. The peripheral neuropathy of vitamin B12 deficiency. In: Journal of the Neurological Sciences, 1984. vol. 66, nr. 1, pp.117-126. https://doi.org/10.1016/0022-510X(84)90147-3
17. NOGAI, L., LUNGU, S., BATIN, T. Dificultăţi de diagnostic diferenţial între mieloza funiculară cu evoluţie atipică şi mielita idiopatică. In: Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, 2019. nr. 2(62), pp.93-95. ISSN 1857-0011
18. SCALAIS, E. et al. Would early versus late hydroxocobalamin dose intensification treatment prevent cognitive decline, macular degeneration and ocular disease in 5 patients with early-onset cblC defi ciency? In: Molecular Genetics and Metabolism, 2023. vol. 140, nr. 3, 107681. https://doi.org/10.1016/j.ymgme.2023.107681
19. SEAGE, C.H. et al. A systematic review of symp toms of pernicious anemia. In: Food and Nutrition Bulletin, 2024. 45(1_suppl), S34-S39.
https://doi.org/10.1177/03795721241227016
20. SETHI, N.K., ROBILOTTI, E., SADAN, Y. Neurological manifestations of vitamin B12 deficiency. In: Internet Journal of Nutrition and Wellness, 2005. vol. 2, pp.1-12. https://doi.org/10.5580/5a9
21. STĂNESCU, A. et al. Problematica diagnosticării deficitului de vitamina B12. In: Romanian Medical Journal, 2019. vol. 66, pp.327-330.
https://doi.org/10.37897/RMJ.2019.4.6
22. UENO, A. et al. Influences of vitamin B12 supplementation on cognition and homocysteine in patients with vitamin B12 deficiency and cognitive impairment. In: Nutrients, 2022. 14, 1494. https://doi.org/10.3390/nu14071494
23. UMEKAR, M. et al. Vitamin B12 deficiency and cognitive impairment: A comprehensive review of neurological impact. In: Brain Disorders, 2025. vol. 18, 100220. https://doi.org/10.1016/j.dscb.2025.100220
24. ZHOU, L. et al. 2024. Characterizing vitamin B12 deficiency in neurology outpatients: A retrospective observational study. In: Clinical Neuropharmacology. 2025. 47(3), pp.87-96. https://doi.org/10.1097/WNF.0000000000000593
25. ZYRINA, G.V. Neurological manifestation of vitamin B₁₂-deficiency anemia. In: Annals of Clinical and Experimental Neurology. 2014., vol. 8, nr. 1, pp.17-21. https://doi.org/10.17816/psaic196
26. Большой медицинский словарь. 2000.
27. ДЕНИСОВА, А.О., РОМАНОВСКАЯ, С.Н. Неврологические проявления дефицита витамина В12. In: E-Scio, 2023. № 8(83). https://cyberleninka.ru/article/n/nevrologicheskie-proyavleniya-defitsita vitamina-v12
28. ЕКУШЕВА, Е.В. и др. Проблема дефицита витамина B12: актуальность, диагностика и таргетная терапия (по материалам междисциплинарного совета экспертов с международным участием). В: Журнал неврологии и психиатрии им. С.С. Корсакова, 2021. т. 121, № 11, с.17-25.
29. ЗИНОВЬЕВА, О.Е. и др. Неврологические проявления дефицита витамина В12. В: Эффективная фармакотерапия, 2021. т. 17, № 6, с.22-28. https://doi.org/10.33978/2307-3586-2021-17-6-22-28
30. СУПОНЕВА, Н.А. и др. Дефицит витамина B12 в контексте неврологических нарушений. В: Эффективная фармакотерапия, 2025. т. 21, № 17, с.22-26. https://doi.org/10.33978/2307-3586-2025-21-17-22-26 Клинико-лабораторная характеристика фуникулярного миелоза.
31. ШАТОХИН, Ю.В. и др. В: Медицинский вестник Юга России, 2010. № 2, с.87-89.
32. ШАТОХИН, Ю.В. и др. В: Медицинский вестник Юга России, 2010. № 2, с.87-89.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
