Drtweetie
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A 73 yo woman has had several weeks of forgetfulness, paresthesias in her feet, and unsteady gait. On PE< she's fully oriented but has mild impairment of recent memory ans is mildly inattentive and irritable. Her gait is unsteady and broad-based, and she's unable to walk tandem. Cranial nerves and strength are normal, but muscle tone is mildly increased in her legs. Sensation to pain, temp, and touch is mildly decreased bilaterally below the midthoracic area. Sensitivity to vibration is decreased at ankles and knees, and proprioception is decreased at toes and ankles. Tendon reflexes are absent at knees and ankles; plantar responses are extensor.
Her Hct is 36%, MCV 90, WBC 5400, Plt 200,000. Rare hypersegmented polymorphonuclear leukocytes are seen on blood smear. CT of head and spine shows only mild, diffuse cerebral atrophy.
Which one of the following is the most likely diagnosis?
a. Spinal cord neoplasm
b. Folic acid deficiency
c. Normal-pressure hydrocephalus
d. Alcohol abuse
e. Vitamin B 12 deficiency
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| Ivonne
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Vit B 12 deficiency
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| Drtweetie
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| cirus
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How is it vit B 12 def with a normal MCV????
the present really points at Vit B12 but MCV 90 is normal!!
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| Drtweetie
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I thought like you too, cirus, but the explanation is that nearly 1/4 of pts w/ vit B12 def and neuro disease have nl Hct &HCt, and some do not even show macrocytosis. The clue in this pts is the presence of hypersegmented polymorphonuclear leukocytes on blood smear.
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| cirus
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wow, i agree that Vit B12 was the first thing i thought about, but the MCV terminated that thought, but practically speaking, non of the choices could be the reasons for her sympts all together exept VitB12.
Good Q
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| liliaeliz
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vitamin B 12 def. :dementia,ataxia (espinocerebellar),touch propiocepcion vibration(dorsal columns),parestesias ,hiperreflexia or hyporreflexia ,increase tone (lateral corticospinal) babinsky, MCV is normal because sometime subacute combined degeneration present before or aisolated the anemic syndrome everthing are o.k exept decrease temperature ,pain because the spinothalamic tracts is intact
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| cirus
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liliaeliz wrote:
vitamin B 12 def. :dementia,ataxia (espinocerebellar),touch propiocepcion vibration(dorsal columns),parestesias ,hiperreflexia or hyporreflexia ,increase tone (lateral corticospinal) babinsky, MCV is normal because sometime subacute combined degeneration present before or aisolated the anemic syndrome everthing are o.k exept decrease temperature ,pain because the spinothalamic tracts is intact
but u didn't see that she already has anemia as her hc 36, though its mild, it indicates that Vit B12 is deficient, meaning a DNA abnormality n RBCs synthesis & so increased MCV
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| Justice
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e. Vitamin B 12 deficiency
Whereas MCV is ~normal, hypersegmented PMNs help to choose (E)
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