以自主神經功能病變爲初始表現之維他命B12缺乏症：病例報告

Autonomic Dysfunction as the Initial Presentation of Vitamin B12 Deficiency: A Case Report

李鴻斌(Hun-Pin Lee) ； 梁蕙雯(Huey-Wen Liang) ； 李棟洲(Tung-Chou Li)

《台灣復健醫學雜誌》 38卷2期 (2010/06) Pp. 131-136

https://doi.org/10.6315/2010.38(2)08

摘要

維他命B12缺乏症可能合併神經病變，其中以脊髓病變最爲常見，但以自主神經功能病變爲初始表現的案例十分罕見。本病例爲76歲男性，以多次昏厥的自主神經功能病變爲初始症狀，後續出現震動覺及本體感覺下降，並產生漸進式四肢無力。經血液學、胃部切片及神經電學檢查證實爲慢性萎縮性胃炎導致維他命B12缺乏症，合併大球性貧血、脊髓病變、周邊神經病變及自主神經病變。本文呈現此病例之臨床表現，回顧過往文獻中，維他命B12缺乏症相關神經病變之臨床症狀與實驗室檢查，以及補充療法及復健治療的預後，以供臨床醫師參考。

關鍵字

維他命B12缺乏症 ； 自主神經功能異常 ； 神經病變

並列摘要

Background: Vitamin B12 deficiency may be associated with variable neurological involvement, and myelopathy is the most common disorder associated with this deficiency. However, initial presentation with autonomic dysfunction is very rare.
Case: The present report describes the case of a 76-year-old man who initially presented with recurrent syncope, followed by impaired vibration and proprioception, and then progressive weakness of the limbs.
Result: The findings of a hematological study, blood biochemistry, gastric biopsy by panendoscopy, and electrophysiological examinations all supported the diagnosis of chronic atrophic gastritis-related vitamin B12 deficiency associated with macrocytic anemia, myelopathy, peripheral neuropathy, and autonomic dysfunction.
Conclusion: We presented the clinical characteristics of this case, and discussed the clinical course and outcome of rehabilitation after supplementation with vitamin B12.

並列關鍵字

vitamin B12 deficiency ； autonomic dysfunction ； neuropathy