Image IQ: Depression, Tingling and Numbness

A 38-year-old woman went to the doctor with several complaints that seemed unrelated but they had started within the last few months. She was feeling depressed and fatigued, with no interest in her normal activities. She was experiencing many more headaches than usual and was having trouble with her memory. She thought it might just be a bout of depression, which she has experienced occasionally since her teens. She was also having tingling and numbness in her hands and feet that was near constant.

Can you diagnose this patient? Use the differential builder in VisualDx for guidance.

A. Vitamin B12 deficiency
B. Migraine headache
C. Depression
D. Systemic lupus erythematosus

See the next page for the answer.

The correct answer is A) Vitamin B12 deficiency

Synopsis

Patients with a vitamin B12 deficiency classically present with megaloblastic anemia, atrophic glossitis, localized or generalized skin pigmentation, neurological changes characterized by symmetrical lower extremity neuropathy greater than upper extremity neuropathy with paresthesia and ataxia that may progress to weakness, spasticity, cerebellar ataxia, and personality changes. Concomitant folate deficiency is often present and may mimic many symptoms of vitamin B12 deficiency.

For more information about this diagnosis, including ICD 10 codes, visit VisualDx.