1. September 7, 2011
Sean Lennox

2. • Vitamin B-12 is involved in immunological responses, and
central and peripheral nervous system maintenance and repair.
• This disease can cause significant degeneration of the
CNS and the peripheral and spinal nerves, causing poor
gait and postural stability because of the paresthesia of
the extremities as well as the joints.
• Dementia and MS.

3. • Metabolized in the stomach and large intestine.
• Stored in the liver.
• Attained by eating meat and animal by-products.
• B-12 binds to homocysteine or methylmelonic acid
(MMA) to form important metabolites for cellular and DNA
repair.

4. Poor uptake can be caused by:
• Stomach or intestinal infection or disease
• Autoimmune gastritis.
• Pernicious anemia and H pylori infection
• Simple poor or incomplete absorption by lack of B-12
intake or hypoacidity of stomach enzymes.
• antacids, post gastrectomy, or even MS anti-inflammatory
medications

5. • vitamin B-12 deficiency appears to increase with age -
over 65 and for those who do not eat animal products
(Carmel, 1997).
• The prevalence has been estimated at around 15% for
patients over 65 years of age and 3% of the general
population (Oh and Brown, 2005).

6. • Case history- Patient reports unsteadiness, poorer than
normal coordination, and numbness of extremities.
• Blood tests of serum vitamin B-12 and vitamin B-
12 agonists (homocysteine and methylmelonic acid)
• The most sensitive diagnostic procedure is to test either
serum homocysteine or MMA levels as both tests have
over 95% sensitivity (Oh and Brown, 2005).
• Low serum B-12 is considered less than 200 pgs.

7. • Oral supplementation treatment is accomplished by
having the patient take 1000 mcgs of vitamin B-12 daily
for the rest of their lives (Oh and Brown, 2005).
• Intramuscular injections which are no more effective
than oral supplementation involve an injection of 100-
1000mcgs per day for life.

8. • The patient should see improved balance functioning
through recovery of pressure sensory cell function and
proprioception, reduced pain and tingling in the
extremities, and improved overall cognition and mental
acuity
• ENG and vestibular tests are typically normal- Romberg
and posturography may be more predictive of functional
balance.

9. • Oh DL., and Brown. (2003). Vitamin B12
deficiency, American Family Physician, 67: 979–986.
• Stabler, Lindenbaum, and Allen. (1997) Vitamin B-12
deficiency in the elderly: current dilemas. American
Journal of Clinical Nutrition, 66:741-749.