Man, 55, suffers falls and loses brain cells prior to vitamin B12 deficiency diagnosis

Vitamin B12 is a vital nutrient needed by the body to help create red blood cells. Without enough B12 you won’t have enough healthy red blood cells to transport oxygen across the body. This can lead to a myriad of serious symptoms.

In the case of one patient, a B12 deficiency left him suffering from “repeated” falls, dizziness, fatigue and weakness prior to a diagnosis. His story was shared in the Journal of Medical Case Reports in 2014.

The case study explained: “A 55-year-old man of east African descent presented to our community hospital with a history of repeated falls, postural dizziness, progressive fatigue, generalised weakness and 30 pound weight loss over the course of three to six months.

“His collateral history obtained from family members confirmed a significant behavioural change over the past year, during which they observed irritability and emotional lability, as well as difficulty with self-care, grooming and personal hygiene.

“He was high-functioning before the onset of his present illness. During a review of systems, he denied any sensory deficits, visual impairment or taste perversion, and he also denied any history of bleeding, bruising or recent infection.

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“His past medical history was unremarkable. He was not taking any medications at the time of presentation.

“The patient denied smoking, alcohol consumption or illicit drug use. He had no significant family history of any illness.”

After being admitted to the emergency department, medical staff noted he was a “poorly groomed” and “dishevelled” man who looked “older than his stated age”.

“He was irritable, paranoid, delusional and highly circumstantial and had grandiose thoughts and impaired insight,” the study added.

A blood test revealed his vitamin B12 levels were 22 picomoles per litre (pmol/L).

This is considerably lower than what is considered to be healthy – 118 to 701 pmol/L.

An MRI scan also showed he had mild cerebral atrophy – a condition “consistent with vitamin B12 myelopathy” that can cause people to lose brain cells and reduce the connection between their brain cells and brain volume.

What caused his deficiency?

Doctors believed he was suffering with pernicious anaemia, a condition that causes your immune system to attack the cells in your stomach.

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This means your body is unable to absorb vitamin B12.

However, it added: “The patient’s long-standing vegetarian diet may also have been a contributor to his vitamin B12 deficiency.”

Vitamin B12 is mainly found in animal product foods, including:

  • Meat
  • Fish
  • Cheese
  • Eggs
  • Milk
  • Fortified cereals.


Due to the severe nature of this case the patient was initially given a transfusion of two units of packed red blood cells following his admission.

He was then given daily injections of vitamin B12 at 1,000 micrograms for one week, followed by weekly injections for the next four weeks. He was subsequently prescribed monthly injections to be continued indefinitely.

The study said: “Within the first week of treatment, the patient’s pancytopenia (deficiency of red cells, white cells, and platelets) had nearly resolved.

“His neuropsychiatric symptoms and cognition had also improved significantly by the time of hospital discharge.

“At follow-up three months later, the patient’s neuropsychiatric impairment had completely resolved.”

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