A Case of Pseudothrombotic Microangiopathy Presenting with Cognitive Dysfunction

Yıl 2024, Cilt: 7 Sayı: 1, 78 - 82, 30.04.2024

İldeniz Bilgiçler Suleyman Emre Kocyıgıt

https://doi.org/10.47141/geriatrik.1402994

Öz

Cognitive dysfunction is one of the leading reasons for admission to the geriatric unit in older adults. These patients should be evaluated primarily in the presence of dementia within the framework of comprehensive geriatric assessment. Many clinical presentations can mimic dementia in elderly individuals. In this respect, the differential diagnosis of cognitive dysfunction should be made carefully. One of the causes of reversible dementia in the elderly may develop secondary to vitamin B12 deficiency. In geriatric practice, vitamin B12 deficiency seen mostly mild to moderate and no other laboratory changes are observed. A thrombotic microangiopathy (TMA)-like condition secondary to vitamin B12 deficiency is very rare in older adults, and it is not common to present with a severe laboratory changes and accompanying cognitive dysfunction. A case report was presented about pseudo-TMA secondary to vitamin b12 deficiency and concurrent cognitive dysfunction that affects daily living activities and in addition, cognitive improvement after vitamin B12 supplementation was observed.

Anahtar Kelimeler

Vitamin B12 Deficiency, Thrombotic Microangiopathies, Cognitive Dysfunction

Kognitif Disfonksiyon ile Başvuran Bir Psödo Trombotik Mikroanjiopati Vakası

Öz

Yaşlılarda kognitif disfonksiyon geriatri birimine önde gelen başvuru sebeplerindendir. Bu tür hastalar ayrıntılı geriatrik değerlendirme çerçevesinde ön planda demans açısından değerlendirilmelidir. Yaşlı bireylerde pek çok klinik tablo demansı taklit edebilmektedir. Bu açıdan kognitif disfonksiyonun ayırıcı tanısı dikkatli bir şekilde yapılmalıdır. Yaşlılarda geriye döndürülebilir demans sebeplerinden biri de vitamin B12 eksikliğine sekonder gelişebilmektedir. Geriatri pratiğinde çoğunlukla vitamin B12 eksikliği hafif-orta düzeyde olup, başka bir laboratuvar değişiklik gözlenmemektedir. Vitamin B12 eksikliğine ikincil trombotik mikroanjiopati (TMA) benzeri tablo yaşlı bireylerde oldukça nadir olup, ön planda gürültülü bir laboratuvar tablo ve bununla beraber kognitif disfonksiyon ile başvurması da sık görülmemektedir. Vitamin B12 eksikliğine sekonder psödo TMA tablosu ve günlük yaşam aktivitelerini etkileyecek düzeyde kognitif disfonksiyon ile başvuran; vitamin B12 replasmanı sonrası kognitif iyileşme gösteren bir olgu sunumu yapılmıştır.

Anahtar Kelimeler

Vitamin B12 Eksikliği, Trombotik Mikroanjiopatiler, Kognitif Disfonksiyon

Kaynakça

• Lopez OL, Kuller LH. Epidemiology of aging and associated cognitive disorders: Prevalence and incidence of Alzheimer’s disease and other dementias. Handb Clin Neurol. 2019;167:139-148.
• Cerasuolo JO, Azarpazhooh MR, Kapral MK, et al. Evidence of Concomitantly Increasing Stroke and Dementia Prevalence among those 80 Years and Older in Ontario, Canada, 2003-04 to 2012-13. Can J Neurol Sci. 2019 Jan;46(1):105-107.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
• Fisman M. Pseudodementia. Prog Neuropsychopharmacol Biol Psychiatry. 1985;9(5-6):481-4.
• Ates Bulut E, Soysal P, Aydin AE, et al. Vitamin B12 deficiency might be related to sarcopenia in older adults. Exp Gerontol. 2017 Sep;95:136-140.
• Fahmawi Y, Campos Y, Khushman M, et al. Vitamin B12 deficiency presenting as pseudo-thrombotic microangiopathy: a case report and literature review. Clin Pharmacol. 2019 Aug 27;11:127-131.
• Shatzel JJ, Taylor JA. Syndromes of Thrombotic Microangiopathy. Med Clin North Am. 2017 Mar;101(2):395-415.
• Vesely SK, George JN, Lämmle B, et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood. 2003 Jul 1;102(1):60-8.
• Patton JF, Manning KR, Case D, et al. Serum lactate dehydrogenase and platelet count predict survival in thrombotic thrombocytopenic purpura. Am J Hematol. 1994 Oct;47(2):94-9.
• de Castro JTS, Appenzeller S, Colella MP, et al. Neurological manifestations in thrombotic microangiopathy: Imaging features, risk factors and clinical course. PLoS One. 2022 Sep 21;17(9):e0272290.
• Morrissey D, Sun Y, Koilpillai S, et al. Pseudo-Thrombotic Microangiopathy Secondary to Vitamin B12 Deficiency. Case Rep Med. 2022 Sep 3;2022:7306070.
• Tun AM, Myint ZW, Rojas Hernandez EG, et al. Vitamin B12 deficiency-related pseudo-thrombotic microangiopathy might be misdiagnosed and treated with plasma product therapy: review of the literature and analysis of the reported cases. Blood. 2017;130:p. 5576.
• Rao S, Colon Hidalgo D, Doria Medina Sanchez JA, et al. Et Tu, B12? Cobalamin Deficiency Masquerading As Pseudo-Thrombotic Microangiopathy. Cureus. 2020 Jul 9;12(7):e9097.
• Hassouneh R, Shen S, Lee O, et al. Severe Vitamin B12 Deficiency Mimicking Microangiopathic Hemolytic Anemia. J Hematol. 2021 Aug;10(4):202-205.