{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:42:38Z","timestamp":1762875758820,"version":"3.44.0"},"reference-count":3,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2016,2,24]]},"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:p>A 22-year-old woman presented with progressive sensory ataxia and optic neuropathy. Previous investigation by her general practitioner had found a low serum vitamin B<jats:sub>12<\/jats:sub>, which had been corrected with oral supplementation. Neurological investigations showed raised plasma homocysteine and methylmalonic acid towards the upper limit of normal with a low serum vitamin B<jats:sub>12<\/jats:sub>. MRI showed an extensive cord lesion in keeping with subacute combined degeneration of the spinal cord. We treated her with high dose parenteral vitamin B<jats:sub>12<\/jats:sub> and she has made a partial recovery. We discuss the management of patients who present with neurological manifestations of vitamin B<jats:sub>12<\/jats:sub> deficiency; highlighting the fact that parenteral replacement is needed in such cases, even if the serum vitamin B<jats:sub>12<\/jats:sub> level appears to be normal. We also discuss ancillary investigations that should be performed in patients with suspected vitamin B<jats:sub>12<\/jats:sub> deficiency.<\/jats:p>","DOI":"10.1136\/practneurol-2015-001344","type":"journal-article","created":{"date-parts":[[2016,3,24]],"date-time":"2016-03-24T00:26:23Z","timestamp":1458779183000},"page":"308-311","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["The difficulties with vitamin B<sub>12<\/sub>"],"prefix":"10.1136","volume":"16","author":[{"given":"Ruth","family":"Dobson","sequence":"first","affiliation":[{"name":"Hurstwood Park Neurosciences Centre, Haywards Heath"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debie","family":"Alvares","sequence":"additional","affiliation":[{"name":"Hurstwood Park Neurosciences Centre, Haywards Heath"},{"name":"St Richards Hospital, Chichester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,3,23]]},"reference":[{"key":"2025090410384288000_16.4.308.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5226"},{"key":"2025090410384288000_16.4.308.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1113996"},{"key":"2025090410384288000_16.4.308.3","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1182\/blood.V92.4.1191","article-title":"Effective treatment of cobalamin deficiency with oral cobalamin","volume":"92","author":"Kuzminski","year":"1998","journal-title":"Blood"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/practneurol-2015-001344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T17:38:47Z","timestamp":1757007527000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/practneurol-2015-001344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3,23]]},"references-count":3,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2016,7,14]]},"published-print":{"date-parts":[[2016,8]]}},"alternative-id":["10.1136\/practneurol-2015-001344"],"URL":"https:\/\/doi.org\/10.1136\/practneurol-2015-001344","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"type":"print","value":"1474-7758"},{"type":"electronic","value":"1474-7766"}],"subject":[],"published":{"date-parts":[[2016,3,23]]}}}