Disclosures: Ryan N. McCarter, MD: No financial relationships or conflicts of interest
Case Description: The patient was admitted to the hospital for progressive weakness of 6 months in duration accompanied by increasing falls as well as a 30lb weight loss with gait ataxia. In the emergency room, CT imaging of the patient’s brain and basic lab work were unremarkable, however given that the patient was experiencing bowel and bladder incontinence, she was admitted to the hospital for observation. Upon admission, the patient had exam findings of bilateral hand musculature atrophy, possible tongue fasciculations, as well as clonus in the bilateral lower extremities. Further workup was initiated including CBC, CMP, as well as MRI of the patient’s brain and spine which showed no clear etiology of the patient’s symptoms. An EMG/NCS was obtained to rule out ALS given the physical exam findings listed above, which showed no gross polyneuropathy or lower motor neuron pathology. Vitamin B12 levels drawn earlier in the admission resulted with level below normal range, prompting treatment with high dose B12 supplementation.
Setting: Large Academic Medical Center
Patient: A 52 year old female with past medical history of hypertension, migraine, chronic pain with extensive past neurosurgical history including cerebellar hemorrhage complicated by abscess formation, as well as fusion of C3-C5 due to spondylosis who presented to the hospital with diffuse progressive weakness. Assessment/
Results: Two months post initiation of B12 supplementation, the patient has experienced a return to near her baseline function, no bowel or bladder incontinence, improved cognition and overall independence.
Discussion: The reason for this case report is to shed more light on the variable presentation of vitamin deficiencies in rehab patients
Conclusion: B12 deficiency is reversible, can result in loss of function and quality of life and in extreme cases can mimic other more severe conditions such as ALS
Level of Evidence: Level V
To cite this abstract in AMA style:
McCarter RN, Weider K, Chandler L. B12 Deficiency Presenting as an ALS Mimic [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/b12-deficiency-presenting-as-an-als-mimic/. Accessed May 8, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/b12-deficiency-presenting-as-an-als-mimic/