Subacute combined degeneration of spinal cord, optic atrophy and thrombocytopenia without anemia secondary to B12 deficiency

Long-standing vitamin B12 deficiency can lead to neurological manifestations such as optic atrophy and subacute combined degeneration of the cord without causing significant anemia. In addition, folic acid supplementation could mask hematological delay presentation We present a case 32-year-old vegan woman on long-term sodium valproate treatment presenting with progressive weakness bilateral lower limbs for three months reduced vision in both eyes two weeks duration. Further evaluation revealed atrophy, spinal cord, macrocytosis, thrombocytopenia, severely deficient serum levels. With replacement therapy, patient’s overall wellbeing improved.