Acquired Immunodeficiency Syndrome and the Nervous System-Reply

Marinos Dalakas, MD
JAMA. 1990;263(1):37-38. doi:10.1001/jama.1990.03440010035021.
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In Reply.—  Dr Stewart-Pinkham states that the workup of our patient with neuropathy is inadequate because the neuropathy could have been due to B12 deficiency, but this is incorrect. We know that B12 deficiency can cause neuropathy even in the absence of anemia and macrocytosis, and it has been part of our routine workup to consider and screen every patient with acquired neuropathy for B12 deficiency.1 Dr Stewart-Pinkham, however, should be reminded that the neuropathy of B12 deficiency is axonal, and when the B12 level is normal, the neuropathy is mild and predominantly sensory.2 In contrast, our patient had a demyelinating neuropathy with conduction block that presented with a subacute onset of a steadily progressive muscle weakness, leading to wheelchair confinement, sensory loss, and elevated protein level in the spinal fluid, all features diagnostic of chronic inflammatory relapsing demyelinating polyneuropathy.3 This neuropathy


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