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Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B12 deficiency

Vitamin B12 deficiency has a wide spectrum of clinical presentation with a variety of neurological symptoms and signs. As a result, many patients lack classic features of advanced severe deficiency. Early diagnosis and treatment are crucial in order to prevent the irreversible damage to the nervous system. We describe a 25-year-old man, who presented with predominant sensory symptoms without any signs on clinical evaluation. His serum vitamin B12 levels were low and neuroimaging revealed myelopathy. The patient was treated promptly with cyanocobalamin injections, which lead to a rapid resolution of symptoms and radiological abnormalities.