Tableau neuro-psychiatrique revelant une maladie de Biermer en l'absence d'anemie. A propos de 3 observations

In addition to an anemic syndrome, pernicious disease can also include neuropsychiatric manifestations. We report here three cases diagnosed as pernicious disease revealed by neuropsychiatric symptoms and even without anemia. Our patients were made of a man and tow women with a mean age of 55 years. They consulted for progressively worsening troubles of step which were related to a combined degeneration of the cord. This degeneration was associated to a cerebellar syndrome in one case. An isolated macrocytosis with a mean MGV at 109 ft, was noticed allowing thus to evoke the Biermer pernicious disease. This diagnosis was confirmed by the marrow puncture which showed a medullar megaloblastosis in two cases and an erythroblastic nucleocytoplosmic maturation's asynchronism. Treated by vitamin B12 the evolution was favorable in two cases with a total neurological recovery after six months in two patients. One patient died after six days of treatment Following an acute myocardial infarction. If faced to symptoms made of a combined degeneration of the spinal card, a periphery neuropathy and/or psychiatric troubles, pernicious disease is a diagnosis that we must evoke even in absence of anemia

Interpretation d'une hypertransaminasemie

Raised serum level of transaminases aspartate [aminotransferase and alanine aminotransferase] is a frequent situation in medical practice. It is considered as moderate when the level is under 10 times normal and as chronic when it lasts for more than 6 months. The most common etiologies for chronically elevated transaminases are alcohol use, viral hepatitis, liver steatosis, diabetis, obesity and medications. Many non invasive tests, including history, physical examination, blood tests [markers for hepatitis A AND B, muscular enzymes], and imaging procedures [abdominal ultrasonography] are usually done and lead to a correct diagnosis in 80% of patients. When the diagnosis cannot be determined non invasively a liver biopsy is recommended in order to make diagnosis, to evaluate the prognosis and to start an adapted treatment