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pernicious anemia and neuropathy

  I am  a 37yr old female with IDDM and hypothyroidism ( Hashimotos)and
  recently developed peripheral neuropathy affecting all extremities and
  the left side of the face. Symptoms included numbness, tingling in affected
  parts. Also nausea, headaches, depth perception problems and arthralgia
  affecting the finger joints. This occurred acutely 7 weeks ago and was
  preceded by neck pain of about 10 days duration. The initial diagnosis
  was acute onset diabetic neuropathy, but as further clinical signs
  appeared - extreme fatigue, shooting pains down my arms - my physician
  thought a B12 deficiency may be at the root of the symptoms ( a lot of
  blood work had been performed to rule out many diseases at the onset),
  he started me on B12 last week and I no longer feel exhausted,
  the arthralgia is almost gone, no nausea etc.
  The question I have is : The character of the nervous signs has changed
  dramatically, instead of numbness, it is more like vibrations, and
  intense tingling, the left side of my face has improved somewhat and there
  are times during the day and night when I have no symptoms whatsoever.
  If this is indeed a B12 deficiency - I realize that things may take time
  to get better - Are the symptoms I am experiencing a result of nerve
  repair? Could this still fit the clinical picture of diabetic neuropathy?
  I appreciate your time.    Sandy in Canada
Thanks for your question.  The symptoms described in your message are indeed
highly suggestive of a sensory peripheral polyneuropathy (PN).  Both diabetes
and Vit. B12 deficiency can caused PN.  The B12 deficiency can be detected
with blood levels of B12 or of methylmalonic acid - the latter being more
sensitive.  Treatment with B12 replacement will usually resolve the symptoms
in 4-6 weeks.  It is difficult to determine if the "evolution" of your
symptoms are a result of the improvement due to B12 replacement.  The
spinal cord lesions that result from B12 deficiency usually start in the
so-called "posterior columns".  This region contains the nerve fiber responsible
for the "proprioception" and "vibration sense", therefore the patient often
complains about "clumsiness" with hands, unsteady gait, difficulties with
standing (particularly with eyes closed).  In a later stage, the nerve
fiber controlling the muscles can be affected and patients complain about
weakness (initially in the lower extremities).
Because your symptoms seemed to have improved with B12 replacement, it is
more likely that B12 deficiency was indeed the cause.  However, diabetic
neuropathy cannot be completely excluded, and the treatment for diabetic
PN is strict/tighter control of blood glucose levels.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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