Reversible dementia, psychotic symptoms and epilepsy in a patient with Vitamin B 12 deficiency

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Vitamin B 12 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 B 12 deficiency found in the literature, symptom reversibility and the importance of its early recognition and treatment.

Original languageEnglish
Article numbere229044
JournalBMJ case reports
Issue number5
Publication statusPublished - 14 May 2019


  • epilepsy and seizures
  • memory disorders
  • pernicious anemia
  • psychotic disorders (incl schizophrenia)


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