Journal of Physical Medicine Rehabilitation & Disabilities Category: Medical Type: Case Report
Postural Disorders in Neuromyelopathy by Deficiency in Vitamin B12
- Diagne NS1*, Cissé O2, Abou S3, Bila E2, Fogang FY2, Gaye NM2, Sow A2, Basse A2, Ndiaye M2, Diop AG2, Ndiaye MM2
- 1 Service De Medecine Physique Et Readaptation Fonctionnelle, Teaching Hospital Of Fann, Dakar, Senegal
- 2 Service De Neurologie, Teaching Hospital Of Fann, Dakar, Senegal
- 3 Service De Psychiatrie, Teaching Hospital Of Fann, Dakar, Senegal
*Corresponding Author:Diagne NS
Service De Medecine Physique Et Readaptation Fonctionnelle, Teaching Hospital Of Fann, Dakar, Senegal
Received Date: Apr 08, 2016 Accepted Date: Jun 29, 2016 Published Date: Jul 13, 2016
Patients with neuromyelopathy by deficiency in Vitamin B12, included and balance disorders evaluated at stand-up and in actions. It was a prospective study which done in Physical Medicine and Rehabilitation department of the Hospital University of Fann, Dakar.
8 patients of which 4 women were included. The average age was 40 years. Palmar melanodermia was constant. The transfer on beds was possible in 7 cases and 1 case needed help. The postural equilibrium sitting position necessitated help in 1 case. The standing position was possible legs spread in 7 cases, impossible joined legs in 7 cases, anteroposterior pushes, laterals , eye closures, the picking up of an object in all the patients caused a destabilization. Head and trunk anteflexion in upstanding, with a pattern of bended head during walking was found is all of our patients. With Vitamin B supplementation and rehabilitation, the support on a leg at 6 months was impossible in more than 10 seconds in all the patients.
Discussion and Conclusion
Postural disorders in neuromyelopathy by deficiency in Vitamin B12 are certainly discrete but constant. They present predominantly by head and trunk anteflexion in upstanding, a loss of lateral gaze during walking and multidirectional oscillations worsened by eyes closure, and pick up of an object on the floor. This is in line with available data in the published literature. For economic reasons, Vitamin B12 dosage is difficult in our setting. Spinal cord degeneration or a sensitive ataxic neuropathy associated with a palmar melanodermia in a black African should prompt a therapeutic test with high doses of Vitamin B12. An accurate and early management often allows recovery of daily living activities.
The neurologic disorders associated with pernicious anemia were well described in the literature of the late nineteenth century and the first decade of this century [1-7]. Certain limitations including uncertainty as to underlying diagnosis and problems in evaluating therapy are noted in previous studies. Since the introduction of various modern diagnostic and therapeutic measures, many reports of neurologic disorders associated with pernicious anemia involving single patients or small numbers of patients have appeared [2,8-12]. Neuromyelopathy by Vitamin B12 deficiency means all manifestations in relation to spinal cord lesions or/and peripherals nerves lesions related to Vitamin B12 deficiency. It is more common in elderly and is under diagnosed because of subtle clinical manifestations . Neuromyelopathy by deficiency in Vitamin B12 is due to a deficit in an intrinsic factor or in an inability to deliver cobalamin from the food or from its carrying proteins [14-16]. Neuromyelopathy by deficiency in Vitamin B12 manifests by profound sensibility [17-19]. Involvement of large sensitive fibers increases the susceptibility to postural disorders. In Tunisia, postural disorders during spinal cord degeneration were evaluated using a stabilimeter. They reported a postural instability in frontal and sagittal plans. Given the predominance of proprioceptive ataxia, these authors already highlighted the importance of postural rehabilitation .
We have carried out a study concerning patients followed up in the service of Physical Medicine and Functional Rehabilitation of Hospital University of Fann, Dakar for neuromyelopathy by deficiency in Vitamin B12. This was a case series study. Cases were collected over a period of 14 months. Neuromyelopathy diagnosis was made upon:
• A progressive onset combined spinal cord degeneration syndrome.
• And/or a sensitive predominant neuropathy.
• Melanodermia of skin and mucosa on black skin.
• A level of Vitamin B12 inferior to 200pg/nl.
• A positive therapeutic challenge with Vitamin B12.
Therapeutic challenge with Vitamin B12 consists in intravenous or intramuscular daily injection of 1000µg of Vitamin B12 for one week. This test is positive if melanodermia and full blood count disorders improve.
Socio-demographic characteristics, results of the neurological examination, upstanding and gait disorders were recorded.
Posture was assessed• In the sitting position: Ability to maintain the sitting position without or with an aid for more than 15 seconds.
• In upstanding: Spontaneous body attitude and the ability to stand with legs open or closed, oscillations during eyes closure, destabilization by pulling and the ability to maintain unipodal support for more than 10 seconds.
• During action: Destabilization or oscillation when picking up an object on the floor, and gaze orientation during walking.
The abnormalities of full blood count, the level of Vitamin B12, the electromyography data and results of MRI were collected. Data analysis is done with Fischer method.
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Citation: Diagne NS, Cissé O, Abou S, Bila E, Fogang FY, et al. (2016) Postural Disorders in Neuromyelopathy by Deficiency in Vitamin B12. J Phys Med Rehabil Disabil 2: 012.
Copyright: © 2016 Diagne NS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.