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Postural Disorders in Neuromyelopathy by Deficiency in Vitamin B12

Neuromyelopathy by deficiency in Vitamin B12 manifests by loss of proprioception which is predominant in lower limbs. Spasticity is less important. These two manifestations lead to an ataxo-spasmodic gait. Posture is defined as the disposition of body segments each one to another. Posture is closely dependent of proprioception, vestibular and visual functions, and muscle tone. Thus, one may expect frequent postural disturbances in neuromyelopathy by Vitamin B12 deficiency. Only few studies on neuromyelopathy by Vitamin B12 deficiency exist. Our study aims to evaluate postural disorders in neuromyelopathy by deficiency in Vitamin B12. Methodology Patients with neuromyelopathy by deficiency in Vitamin B12, included and balance disorders evaluated at stand-up and in actions. It was a prospective study which done in Physical Medicine and Rehabilitation department of the Hospital University of Fann, Dakar. Results 8 patients of which 4 women were included. The average age was 40 years. Palmar melanodermia was constant. The transfer on beds was possible in 7 cases and 1 case needed help. The postural equilibrium sitting position necessitated help in 1 case. The standing position was possible legs spread in 7 cases, impossible joined legs in 7 cases, anteroposterior pushes, laterals , eye closures, the picking up of an object in all the patients caused a destabilization. Head and trunk anteflexion in upstanding, with a pattern of bended head during walking was found is all of our patients. With Vitamin B supplementation and rehabilitation, the support on a leg at 6 months was impossible in more than 10 seconds in all the patients.Discussion and Conclusion Postural disorders in neuromyelopathy by deficiency in Vitamin B12 are certainly discrete but constant. They present predominantly by head and trunk anteflexion in upstanding, a loss of lateral gaze during walking and multidirectional oscillations worsened by eyes closure, and pick up of an object on the floor. This is in line with available data in the published literature. For economic reasons, Vitamin B12 dosage is difficult in our setting. Spinal cord degeneration or a sensitive ataxic neuropathy associated with a palmar melanodermia in a black African should prompt a therapeutic test with high doses of Vitamin B12. An accurate and early management often allows recovery of daily living activities.

Auteur(s) : Diagne NS1*, Cissé O2, Abou S3, Bila E2, Fogang FY2, Gaye NM2, Sow A2, Basse A2, Ndiaye M2, Diop AG2 and Ndiaye MM2
Année de publication : 2016
Revue : HSOA Journal of Physical Medicine, Rehabilitation & Disabilities
Type : Article
Mise en ligne par : DIAGNE Ngor Side