Pernicious anemia may present with decreased proprioception, vibratory sense, hyperreflexia, gait ataxia, and a history of alcohol use. This neurologic presentation is most indicative of which anemia?

Pernicious anemia may present with decreased proprioception, vibratory sense, hyperreflexia, gait ataxia, and a history of alcohol use. This neurologic presentation is most indicative of which anemia?

• A. Folate deficiency anemia
• B. Aplastic anemia
• C. Iron deficiency anemia
• D. Pernicious anemia

Answer: (D)

Neurologic signs like loss of proprioception and vibratory sense with gait ataxia and hyperreflexia point to damage of the dorsal columns and lateral corticospinal tracts from vitamin B12 deficiency. Pernicious anemia is a common cause of B12 deficiency because autoimmune destruction of intrinsic factor impairs B12 absorption. This leads to subacute combined degeneration of the spinal cord, explaining the sensory and motor findings. Folate deficiency can cause macrocytosis but typically lacks these neuro findings. Iron deficiency and aplastic anemia have different hematologic patterns and do not produce this characteristic demyelinating neuropathy. Alcohol history can contribute to nutritional issues, but the described pattern specifically indicates B12 deficiency from pernicious anemia.

Neurologic signs like loss of proprioception and vibratory sense with gait ataxia and hyperreflexia point to damage of the dorsal columns and lateral corticospinal tracts from vitamin B12 deficiency. Pernicious anemia is a common cause of B12 deficiency because autoimmune destruction of intrinsic factor impairs B12 absorption. This leads to subacute combined degeneration of the spinal cord, explaining the sensory and motor findings. Folate deficiency can cause macrocytosis but typically lacks these neuro findings. Iron deficiency and aplastic anemia have different hematologic patterns and do not produce this characteristic demyelinating neuropathy. Alcohol history can contribute to nutritional issues, but the described pattern specifically indicates B12 deficiency from pernicious anemia.