This patient developed vitamin B12 deficiency due to a previous gastrectomy for carcinoma of the stomach.(3,4) He was never placed on B12 replacement or had his B12 levels monitored. Intrinsic factor, produced in the stomach, is necessary for B12 absorption in the terminal ileum. Several years later he presented with imbalance and examination showed impaired position and vibration sense and a positive Romberg sign. His B12 level was 65, markedly reduced.
1. Lanska, DJ and Goetz, CG. Romberg's sign: development, adoption, and adaptation in the 19th century. Neurology. 2000; 55:1201-1206. 2. Meyer MA. Romberg sign: sensory dysfunction, not cerebellar disease. Geriatrics. 1998;53:10. 3. Verma R, Praharaj HN, Khanna VK, Garg RK, Singh MK, Malhotra HS. Study of micronutrients (copper, zinc and vitamin B12) in posterolateral myelopathies. J Neurol Sci. 2013;329:11-6. 4. Hu Y, Kim HI, Hyung WJ, Song KJ, Lee JH, Kim YM, Noh SH. Vitamin B(12) deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Ann Surg. 2013;258:970-5.