• Petchkrua W, Little JW, Burns SP, Stiens SA and James JJ (2003). Vitamin B12 deficiency in spinal cord injury: a retrospective study. J Spinal Cord Med 26:116-21. Summary: BACKGROUND/OBJECTIVE: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI). This retrospective study describes vitamin B12 deficiency in SCI. METHODS: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B12 testing over the last 10 years. RESULTS: Probable vitamin B12 deficiency was noted in 16 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/mL), whereas 4 patients had low-normal vitamin B12 levels [< 300 pg/mL) with neurologic and/or psychiatric symptoms that improved following vitamin B12 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 16 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 16 SCI patients presented with depression and fatigue, 2 had worsening pain, 2 had worsening upper limb weakness, and 2 had memory decline. Of the 12 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B12, macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anemia was identified in 7 of the 16 patients and macrocytic red blood cells were found in 3 of the 16 patients. Only 1 of the 16 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency [ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement [some patients experienced more than 1 benefit), including reversal of anemia [5 patients), improved gait [4 patients), improved mood [3 patients), improved memory [2 patients), reduced pain [2 patients), strength gain [1 patient), and reduced numbness [1 patient). CONCLUSION: It is recommended that physicians consider vitamin B12 deficiency in their patients with SCI, particularly in those with neurologic and/or psychiatric symptoms. These symptoms often are reversible if treatment is initiated early. Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA.