Rev Neurol. 2001 Dec 16-31; 33(12): 1154-7.

[Subacute combined degeneration. A description of the case of a strictly vegetarian child]

Cornejo W, GonzÃ¡lez F, Toro ME, Cabrera D.

Universidad de Antioquia. Facultad de Medicina, MedellÃn, AntioquÃa, Colombia. [email protected]

INTRODUCTION: Cyanocobalamin (vitamin B12) is an essential cofactor of various metabolic pathways. Lack of it leads to symptoms which may be constitutional, of skin or mucous membranes, hematological or neuropsychiatric disorders. Neurological involvement in adults has been well described and analyzed in the literature, however there are fewer cases of children. In the cases described in children the deficiency was related to maternal malnutrition, and socioeconomic and cultural problems. Since vegetarianism is a custom followed by different social groups we wish to draw attention to this as a cause of vitamin B12 deficiency and the neurological disorder this may cause. CLINICAL CASE: We describe the case of a 10 year old boy, a member of a religious community who were strict vegetarians. Over three months he developed: a cognitive disorder, pyramidal syndrome of his legs, involvement of the posterior spinal cord, peripheral motor and sensory alterations which, together with the complementary investigations, was found to be compatible with subacute combined degeneration due to vitamin B12 deficiency. CONCLUSION: We draw attention to the clinical and laboratory aspects of this disorder and the importance of taking the possibility of this diagnosis into account in children with nutritional risk factors.