Serum vitamin B12 deficiency and hyperhomocystinemia:: A reversible cause of acute chorea, cerebellar ataxia in an adult with cerebral ischemia

Patients with vitamin B-12 deficiency have protean neurological manifestations that are often insidious. Acute onset of cerebellar dysfunction and extrapyramidal manifestations like dystonia and chorea are rather uncommon in adults. We describe a patient who manifested with acute onset of language dysfunction, chorea and ataxia. There was no history of hypertension, diabetes or ischemic heart disease. He had low serum vitamin B-12 and elevated serum homocystine levels. He improved dramatically following B-12 replacement therapy. Our patient Provides insight into the pathophysiological mechanism of this rare manifestation. Further the importance of considering vitamin B-12 deficiency, in country like India, where vegetarian food practice is quite common, is being emphasized. (c) 2008 Elsevier B.V. All rights reserved.