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Unusual presentation of more common disease/injury
A 40-year-old woman ‘off legs’
  1. Prerna Mehrotra1,
  2. Ashish Bhalla2
  1. 1Department of Anaesthesia, Nottingham City Hospital, Nottingham, UK
  2. 2Department of General Surgery, Royal Derby Hospital NHS Trust, Derby, UK
  1. Correspondence to Dr Prerna Mehrotra, pmehrotra{at}


We present the case of a 40-year-old woman with progressive lower-limb weakness resulting in an inability to mobilise independently. This was associated with a degree of confusion and shortness of breath on exertion. This case illustrates rare and severe complications of vitamin B12 deficiency, namely subacute combined degeneration of the spinal cord, megaloblastic anaemia and impaired cognitive function. The patient's condition improved considerably with adequate early resuscitation, followed by administration of synthetic vitamin B12 analogues and neuro-rehabilitation.

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