Pearls Oy-sters: Rapidly Reversible Dementia: Vitamin B_12 Deficiency in a 29-Year-Old Woman

摘要

Pearls: ? Vitamin B_12 deficiency affects multiple systems, including hematologic, neurologic, dermatologic, and gastrointestinal. ? Vitamin B_12 deficiency can present with rapidly progressive dementia, which is reversible. Oy-ster: ? Active search for oral, skin, laboratory, and imaging markers of vitamin B_12 deficiency is warranted in patients with rapidly progressive dementia, especially with frontotemporal pattern of cognitive presentation. A 29-year-old woman presented to us with progressive cognitive impairment over a period of 9 months. She was premorbidly well-adjusted, taking care of her child and all household chores. Initial signs of the condition included decreased interaction, withdrawn behavior, apathy, and executive dysfunction. The woman also experienced impaired judgment while cooking, loss of attention during conversations or while speaking, and perseverating behavior like repeatedly folding clothes, followed by episodic memory impairment. As symptoms progressed over the next 6 months, the woman required increased assistance and encouragement to complete daily activities. For example, when asked to take a shower, she simply sat in the restroom. Loss of insight into the illness was, and speech. Speech output gradually reduced to single words. There was no history of other errors in language function. The woman did not have prior history of language difficulty, nor any history suggestive of getting lost in familiar or unfamiliar places, hallucinations, delusions, hemineglect, apraxia, or urine and bowel incontinence. Alternatively, she did have a history of veganism, and amenorrhea for 5 months.