Abstract Details

Title Tongue Fasciculations?Presenting?as an Early Clinical Sign of Cobalamin Deficiency

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-006

Objective A unique case in which an isolated lower motor neuron finding – tongue fasciculations presents as the initial clinical manifestation of B12 deficiency.

Background Vitamin B12 (cobalamin) is a water-soluble vitamin found in nutrition. It is necessary in many functions, including the synthesis of both DNA, RNA and myelin production, particularly in the spinal cord. Cobalamin deficiency can lead to a manifestation of neurologic symptoms, including ataxia, paresthesias, loss of vibratory and position sense, depression, and diminished cognitive function.

Design/Methods NA

Results A 40-year-old female with no significant past medical history presented with a year long history of progressive fatigue, dysphagia to liquids and left sided tongue fasciculations. Exam was notable for visible tongue fasciculations and a very weak gag reflex. Strength, sensation, reflexes and remaining cranial nerves were intact. MRI brain with and without contrast was normal, including the 12th cranial nerves. EMG/NCV of the right upper and lower extremities showed no evidence of a generalized peripheral neuropathy, myopathy, or motor neuron disorder. Laboratory testing was significant for low B12 level: 222 pg/mL. Lyme disease, Anti-MuSK, acetylcholine binding, blocking, modulating antibodies were unremarkable. Patient was supplemented with Vitamin B12 1000 mcg/mL IM every month. After two injections, symptoms dissipated with complete resolution after 6 months.

Conclusions Tongue fasciculations are visible, spontaneous and intermittent contractures of muscle fibers, that are often a neurological finding of concern, reportedly related to motor neuron disorders, most often ALS. However, the degree of skeletal pathophysiological involvement is broad, with tongue fasciculations found in movement disorders, electrolyte disorders, and even stress and fatigue. Physicians should suspect cobalamin deficiency as well in patients with tongue fasciculations in the absence of other neurologic findings.

Authors/Disclosures
Anuradha Singh, DO (Hackensack Meridian Health Network) PRESENTER	Dr. Singh has nothing to disclose.
Jane Shaji, MD (Stony Brook U Hospital, Dept of Neurology)	No disclosure on file
Danielle A. Bazer, DO (Cooper University)	Dr. Bazer has received research support from Keep Punching.
Agnes Kowalska, MD (SUNY At Stony Brook)	Dr. Kowalska has nothing to disclose.