{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:42:58Z","timestamp":1756384978056,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,11,22]]},"abstract":"<jats:p>The aetiology spectrum for neuroregression in infants and toddlers is diverse. Vitamin B<jats:sub>12<\/jats:sub> deficiency-mediated neuroregression is less commonly considered as a differential. Prevalence of pernicious anaemia in the general population is 0.1% and is extremely rare in children. We describe a 35-month-old toddler with neuroregression, seizures, coarse tremors, bleating cry and neuropathy. His clinical symptomatology mimicked grey matter degenerative illness and infantile tremor syndrome, a nutritional deficiency-mediated movement disorder. His vitamin B<jats:sub>12<\/jats:sub> level was low and serum homocysteine level was elevated. Haematological manifestations were not overt and anti-intrinsic factor antibody was positive. With parenteral vitamin B<jats:sub>12<\/jats:sub> therapy, there was a dramatic response with clinical and laboratory translation. This report emphasises the need for a high index of suspicion and screening for markers of vitamin B<jats:sub>12<\/jats:sub> deficiency in all children with unexplained acute or subacute neuroregression, seizures and movement disorders as it is potentially reversible.<\/jats:p>","DOI":"10.1136\/bcr-2015-213540","type":"journal-article","created":{"date-parts":[[2016,2,14]],"date-time":"2016-02-14T18:07:56Z","timestamp":1455473276000},"page":"bcr2015213540","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Neuroregression as an initial manifestation in a toddler with acquired pernicious anaemia"],"prefix":"10.1136","volume":"2015","author":[{"given":"Sangeetha","family":"Yoganathan","sequence":"first","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya Mary","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Mathai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Christian Medical College, Vellore, Tamilnadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Urmi","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Christian Medical College, Vellore, Tamilnadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,12,17]]},"reference":[{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.1","doi-asserted-by":"crossref","first-page":"pii: bcr2013008840","DOI":"10.1136\/bcr-2013-008840","article-title":"Vitamin B12 deficiency presenting as acute ataxia","volume":"2013","author":"Crawford","year":"2013","journal-title":"BMJ Case Rep"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.2","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/pch\/19.2.84","article-title":"Vitamin B12 deficiency with intrinsic factor antibodies in an infant with poor growth and developmental delay","volume":"19","author":"McNeil","year":"2014","journal-title":"Paediatr Child Health"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.3","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e3181d74719"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.4","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2147\/JBM.S25620","article-title":"Optimal management of pernicious anemia","volume":"3","author":"Andres","year":"2012","journal-title":"J Blood Med"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.5","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2008.26947A"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.6","doi-asserted-by":"publisher","DOI":"10.3390\/nu5125031"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.7","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-015-1725-3"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/00005792-199107000-00001","article-title":"Neurologic aspects of cobalamin deficiency","volume":"70","author":"Healton","year":"1991","journal-title":"Medicine (Baltimore)"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2008.00031.x"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.10","first-page":"680","article-title":"Causes and early diagnosis of vitamin B12 deficiency","volume":"105","author":"Herrmann","year":"2008","journal-title":"Dtsch Arztebl Int"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.11","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1093\/ajcn\/82.2.442","article-title":"Biochemical indicators of B vitamin status in the US population after folic acid fortification: results from the National Health and Nutrition Examination Survey 1999\u20132000","volume":"82","author":"Pfeiffer","year":"2005","journal-title":"Am J Clin Nutr"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.12","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1031155"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.revmed.2004.03.008"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2012.00755.x"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.15","doi-asserted-by":"publisher","DOI":"10.3390\/nu5114521"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.16","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cml008"},{"key":"2025082805073238000_2015.dec17_3.bcr2015213540.17","doi-asserted-by":"crossref","unstructured":"Vidal-Alaball J , Butler CC , Cannings-John R , et al . 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