ABSTRACT
INTRODUCTION: Although vitamin B12 deficiency is a well-known cause of hematological and neuropsychiatric illness, the presentation of combined severe pancytopenia, demyelination and prominent psychiatric impairment is rare. CASE PRESENTATION: We present a case of a previously healthy 55-year-old East African man with severe vitamin B12 deficiency (serum vitamin B12 22pmol/L) secondary to pernicious anemia. He had a severe hypoproliferative megaloblastic anemia with hemolysis (hemoglobin 61g/L, mean corpuscular volume 99fL, reticulocytes 0.8%, haptoglobin undetectable), leukopenia (2.7×109/L), thrombocytopenia (96×109/L), ataxia with central demyelination, and megaloblastic madness. The patient's anemia, myelopathy and psychiatric condition responded well to parenteral vitamin B12 replacement therapy, with significant improvement seen within weeks. CONCLUSION: Hematological manifestations of vitamin B12 deficiency are typically inversely correlated with the presence and severity of neuropsychiatric impairment. Although uncommon, a presentation with severe hematological and neuropsychiatric disease can occur, as illustrated by this case. Its presence may help guide diagnosis as well as provide clinically important prognostic information.
Subject(s)
Vitamin B 12 Deficiency/complications , Vitamin B 12/therapeutic use , Anemia, Megaloblastic/drug therapy , Anemia, Megaloblastic/etiology , Diagnosis, Differential , Diagnostic Imaging , Humans , Leukopenia/drug therapy , Leukopenia/etiology , Male , Mental Disorders/drug therapy , Mental Disorders/etiology , Middle Aged , Thrombocytopenia/drug therapy , Thrombocytopenia/etiology , Vitamin B 12 Deficiency/diagnosis , Vitamin B 12 Deficiency/drug therapyABSTRACT
BACKGROUND: Human immunodeficiency virus (HIV) infection frequently results in neurological complications but the impact of different neurological syndromes on patients' quality of life remains unknown. METHODS: We investigated health-related quality of life (HRQoL) parameters among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients with and without neurological disease, including 11 dimensions of HRQoL within the Medical Outcomes Short-form Health Survey-HIV. RESULTS: Comparisons of sociodemographic and systemic clinical variables did not differ between HIV/AIDS patients with (n=94) and without (n=75) neurological disease. However, patients with neurological diseases exhibited significantly lower HRQoL scores compared to matched controls, which was most evident among HIV/AIDS patients with cognitive impairment and sensory neuropathy. Prospective analysis revealed diminishing HRQoL scores prior to neurological diagnosis followed by a progressive and sustained improvement in HRQoL scores after intervention over a 96-week period. CONCLUSIONS: These studies indicate that while HIV-related neurological diseases are associated with reduced HRQoL scores, enhanced neurological care has a positive impact on HIV/AIDS patients' overall well-being.
Subject(s)
AIDS Dementia Complex/psychology , Brain Diseases/psychology , HIV Infections/complications , HIV Infections/psychology , Quality of Life/psychology , AIDS Dementia Complex/physiopathology , Adult , Age Factors , Brain Diseases/physiopathology , Brain Diseases/virology , Cognition Disorders/psychology , Cognition Disorders/virology , Cross-Sectional Studies , Disease Progression , Educational Status , Female , Humans , Ischemic Attack, Transient/psychology , Ischemic Attack, Transient/virology , Male , Middle Aged , Migraine Disorders/psychology , Migraine Disorders/virology , Neuritis/psychology , Neuritis/virology , Peripheral Nervous System Diseases/psychology , Peripheral Nervous System Diseases/virology , Prospective Studies , Seizures/psychology , Seizures/virology , Sex Factors , Surveys and QuestionnairesABSTRACT
The presence of depression is an important concern for patients with multiple sclerosis who are candidates for disease-modifying treatment, since depression may affect treatment adherence. The authors evaluated the positive predictive value of the Center for Epidemiologic Studies Depression Rating Scale (CES-D) in detecting depression among patients who were candidates for disease-modifying multiple sclerosis treatment. Of 47 patients who scored >/=16 on the CES-D, 74.5% (N=38) were found to have a depressive disorder. The results of the study indicate that case-finding for depressive disorders among multiple sclerosis patients can be facilitated by use of the CES-D scale.
