Summary

We report a case of bilateral useless hand syndrome, a rare presenting manifestation of vitamin B₁₂ deficiency. A 38-year-old man, a strict vegetarian and a teacher by occupation, presented with acute onset clumsiness of both hands while performing fine movements. Detailed history-taking, examination of the patient and relevant investigations (complete blood count, serum vitamin B₁₂ and MRI of the cervical spinal cord) were carried out. Laboratory analysis was suggestive of vitamin B₁₂ deficiency and MRI demonstrated a lesion involving the posterior columns of the cervical cord. The patient was diagnosed as a case of non-compressive cervical myelopathy predominantly involving the posterior column due to vitamin B₁₂ deficiency. Acute bilateral useless hand syndrome can be a rare presenting feature of vitamin B₁₂ deficiency.