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Objective: To determine the frequency of various neurological and psychiatric symptoms associated with B12 deficiency.Study design: Observational and descriptive study. Place and duration of study: The study was conducted on patients presenting to theneurology clinics and inpatients who were admitted through the emergency department at Aga khan University Hospital Karachi, from 1stJuly 2011 to March 2012. Subjects and methods: 150 patients of either gender and age more than 18 years. Detailed history was takenfrom all the patients with special regard to anemia. Inclusion criteria were that patients above 18 years of age of either sex with low serumB12 levels. Patients having any type of neurological tumors, major ischemic stroke, major intracranial haemorrhage, patients onneuroleptic medications and any evidence of toxin induced neuropathy were excluded. All patients underwent for specific investigationcomplete blood count, serum B12 levels (derived by Radio Assay method (RIA). Further investigations Nerve Conduction Studies /Electromyography and CT Scan / Magnetic resonance Imaging of the Brain / spinal cord were carried out as and when required,depending on the clinical scenario. Results: There were 69 (46%) males and 81(54%) females. Female to male ratio was 1:0.8. The ageranged between 18 to 90 years with the mean age of 45.7+ 5.6. Out of 150 patients 107 patients (71.3 %) had severe vitamin B 12deficiency while 43 (28.7%) had mild to moderate deficiency. Neurological manifestations which were observed included; Memory wasimpaired in 13 (8.7%) of the patients. Dysarthia, along with other cerebellar signs (Nystagmus and dysdiadochokinesia) was present in9 patients (6%). 4 patients (2.7%) sought medical attention regarding their abnormal gait and their neurological examination revealedextensor planter responses and hyperreflexia. Cranial nerve examination revealed Anosmia in 2 (1.3%) and upper motor neuron facialweakness in 1 (0.66%) patients. Motor weakness was found in 2 patients (1. 3%), and spasticity in 2 (1.3%) patients. 5 patients (3.3%)had sensory complains and were found to have impaired pain and touch perception. Proximal muscle weakness in one patient whileanother patient had asymmetric muscle weakness and rest of the patients had normal muscle power. None of the patient had autonomicdysfunction. In six neuropsychiatric problems were commonly seen in vitamin B 12 deficient people. In these patients depression wasobserved in 16%, agitation 12.7 %, memory impairment 8.7%, cerebellar signs and dysarthria 6%, sensory symptoms 3.3% and gaitabnormality and hyperreflexia and extensor planters 2.7 %. Conclusions: Various Neuropsychiatric problems are associated with vitaminB 12 deficiency and the most common Neuropsychiatric illness found in these patients were depression, agitation, and memoryimpairment.

Squamous cell carcinoma of the thyroid is a rare tumor with a grave prognosis. Most of the patients reported in the literature died within 1 year of diagnosis despite the use of surgery, radiotherapy, and chemotherapy. We describe a case that had surgery followed by radiotherapy, resulting in disease-free survival after 3 years of diagnosis, which is unusual for squamous cell carcinoma of the thyroid.

Most of the Ontario community hospital EDs included in this survey had inadequate facilities for paediatric patients such as specific waiting and treatment areas.