Reversible dementia, psychotic symptoms and epilepsy in a patient with vitamin B₁₂deficiency

Abstract

Vitamin B12 deficiency is a common condition, typically associated with megaloblastic anaemia, glossitis and neuropsychiatric symptoms. We report the case of a patient presenting with progressive cognitive and functional deterioration, psychosis and seizures, later found to be secondary to pernicious anaemia. Importantly, the diagnosis of pernicious anaemia was only established 5 years after symptom onset and was overlooked even when the patient was under medical care, in part due to the lack of classic neurological and haematological signs associated with the condition. The patient had a remarkable neuropsychiatric recovery after vitamin replacement and psychopharmacological management. We discuss similar presentations of vitamin B12 deficiency found in the literature, symptom reversibility and the importance of its early recognition and treatment.

“Severe Anemia: A Case Report of an Uncommon Precipitant of Schizophrenia Relapse”

“…27 Normalization of hematopoiesis could not have occurred in such short period. This is also consistent with other reports in which psychoses occurred in isolated vitamin B12 deficiency without megaloblastic anemia, [28][29][30] pointing to the deficiency's independent effect such as homocysteinemia due to problems in one-carbon metabolisms or abnormalities in synthesis of neurotransmitters. 10,11,31 Similarly, the widely studied iron deficiency anemia is also implicated as the predisposing factor of schizophrenia, [32][33][34] but the mechanism driving development of psychosis appears to be from iron status deviating brain developmental trajectories.…”

The Impact of Low Hemoglobin Levels on Cognitive Brain Functions

“…Vitamin B-12 deficiency is related to progressive cognitive functional decline. A case of Pernicious anemia was found to have a severe decline in neurological functions, and an effective cure happened after giving the patient vitamin B-12 [ 31 ].…”

Hashimoto’s Encephalopathy Revealed by Hypochondriacal Delusion: A Case Report Involving a Male Patient

“…The pathophysiology of this relationship remains unknown. This may be due to the excitotoxic effects of glutamate on the brain neurons with destroyed myelin sheaths secondary to vitamin B12 deficiency ( Akaike et al, 1993 ; Silva et al, 2019 ). Given the lack of improvement of the patient’s symptoms after vitamin substitution, this hypothesis was unlikely.…”