# Methylcobalamin Deficiency Presenting as Thalamic Syndrome in the Elderly: Association or Chance?

## TL;DR

An elderly man's thalamic-like symptoms were caused by vitamin B12 deficiency, highlighting the importance of timely diagnosis to prevent brain damage.

## Contribution

This case report highlights methylcobalamin deficiency as a potential misdiagnosed cause of thalamic syndrome in the elderly.

## Key findings

- A 62-year-old male presented with thalamic-like symptoms caused by methylcobalamin deficiency.
- Symptoms included numbness, tingling, and cognitive disturbances, mimicking a left thalamic infarct.
- The case underscores the need for early detection to prevent irreversible brain damage.

## Abstract

Vitamin deficiency is common in the geriatric population and is responsible for majorly imbalanced hematological, neurological, and neuropsychiatric functioning. Methylcobalamin deficiency or vitamin B12 deficiency can be underestimated in some cases and be misdiagnosed as other illnesses, such as thalamic syndrome. Timely diagnosis of this deficiency is essential, especially in the geriatric population, as it might cause irreversible structural brain damage. This is also presented as elevated levels of homocysteine and methylmalonic acid. Clinically, it presents with the following symptoms: lower sensitivity levels to touch and light, psychosis, paresthesia, anemia, imbalance, fatigue, cognitive disturbances, difficulty remembering, and confusion. Symptoms are usually progressive and worsen over a period of time. In this case report, we present the case of a 62-year-old male with clinical symptoms of numbness and tingling in the right side of the body. The neurological presentations resembled left thalamic infarct, but the underlying reason was methylcobalamin deficiency.