Top

Clinical Neuroradiology

Published in:

01-06-2016 | Original Article

Brain MRI and MR Spectroscopy Findings in Children with Nutritional Vitamin B₁₂ Deficiency

Authors: F. Ekici, MD, G. Tekbas, MD, S. Hattapoğlu, MD, A. Yaramış, MD, H. Önder, MD, A. Bilici, MD

Published in: Clinical Neuroradiology | Issue 2/2016

Abstract

Introduction

Our aim in this study was to analyze the findings of brain magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of children with vitamin B₁₂ deficiency.

Methods

This study included 14 cases. The findings of brain MRI and MRS in all cases were investigated. Four patients had been followed up and mean follow-up time 71.8 (59–85) day.

Results

Eight patients of the cases (57 %) had at least one abnormal MRI finding. The most commonly found MRI findings were thinning of the corpus callosum and brain atrophy, respectively. The mean ratio of NAA/Cr and Cho/Cr were measured in MRS, with values of 1.31 ± 0.17 and 1.04 ± 0.27, respectively. In two of three patients with abnormal MRI studies at presentation, subsequent MRI showed improvement while one patient remained unchanged. An increase in the ratios of metabolites were found in one case with control MRS. There was no lactate peak.

Conclusion

Brain MRI was abnormal in more than half of the cases of children with vitamin B₁₂ deficiency. Our radiologic findings similar with literature. There was no identifiable lactate peak. B₁₂ deficiency could be the cause of the thinning of the corpus callosum and brain atrophy in the children that were given a brain MRI.

Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull. 2008;29(Suppl 2):S126–31.CrossRefPubMedPubMedCentral

Emadfa I, Singer I. Vitamin B-12 and homocysteine status among vegetarians: a global perspective. Am J Clin Nutr. 2009;89(Suppl):1693S–8S.CrossRef

Korenke GC, Hunneman DH, Eber S, Hanefeld F. Severe encephalopathy with epilepsy in an infant caused by subclinical maternal pernicious anaemia: case report and review of the literature. Eur J Pediatr. 2007;163:196–201.CrossRef

Taşkesen M, Yaramış A, Pirinçcioglu AG, Ekici F. Cranial magnetic resonance imaging findings of nutritional B(12) deficiency in 15 hypotonic infants. Eur J Paediatr Neurol. 2011;16:266–70.CrossRefPubMed

Honzik T, Adamovicova M, Smolka V, Magner M, Hruba E, Zeman J. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency—what have we learned? Eur J Paediatr Neurol. 2010;14:488–95.CrossRefPubMed

Ertaş T, Koç A, Koçyiğit A, Baz T. Bebeklerin nöro-motor, sosyal ve fiziksel gelişmeleri üzerine B12 vitamini eksikliğinin etkileri. Çocuk Sağlığı ve Hastalıkları Derg. 2011;54:62–9.

Katar S, Nuri Ozbek M, Yaramis A, Ecer S. Nutritional megaloblastic anemia in young Turkish children is associated with Vitamin B-12 deficiency and psychomotor retardation. J Pediatr Hematol Oncol. 2006;28:559–62.CrossRefPubMed

Von Schenck U, Gotze CB, Koletzko B. Persistence of neurological damage induced by dietary vitamin B12 deficiency in infancy. Arch Dis Child. 1997;77:137–9.CrossRefPubMedPubMedCentral

Hajek M, Dezortova M. Introduction to clinical in vivo MR spectroscopy. Eur J Radiol. 2008;67:185–93.CrossRefPubMed

10.

Kosucu P, Erdemli S, Sonmez M, Kul S, Aksoy A. MR spectroscopic evaluation of psychomotor delay of unknown cause in children. AJR Am J Roentgenol. 2010;94:1110–5.CrossRef

11.

Horstmann M, Neumaier-Probst E, Lukacs Z, Steinfeld R, Ullrich K, Kohlschutter A. Infantile cobalamin deficiency with cerebral lactate accumulation and sustained choline depletion. Neuropediatrics. 2003;34:261–4.CrossRefPubMed

12.

Barkovich AJ, Kjos BO. Normal postnatal development of the corpus callosum as demonstrated by MR imaging. AJNR Am J Neuroradiol. 1998;9:487–91.

13.

Barkovich AJ. Normal development of the neonatal and infant brain, skull and spine. In:Barkovich AJ, editor. Pediatric neuroimaging, 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. pp. 17–75.

14.

Lövblad K, Ramelli G, Remonda L, Nirkko AC, Ozdoba C, Schroth G. Retardation of myelination due to dietary vitamin B12 deficiency: cranial MRI findings. Pediatr Radiol. 1997;27:155–8.CrossRefPubMed

15.

Graham SM, Arvela OM, Wise GA. Long-term neurological consequences of nutritional VB12 deficiency in infants. J Pediatr. 1992;121:710–4.CrossRefPubMed

16.

Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev. 2008;66:250–5.CrossRefPubMed

17.

Lam WW, Wang ZJ, Zhao H, Berry GT, Kaplan P, Gibson J, Kaplan BS, Bilaniuk LT, Hunter JV, Haselgrove JC, Zimmermann RA. 1H MR spectroscopy of the basal ganglia in childhood: a semiquantitative analysis. Neuroradiology. 1998;40:315–23.CrossRefPubMed

18.

Filippi CG, Ulug AM, Deck MD, Zimmerman RD, Heier LA. Developmental delay in children: assessment with proton MR spectroscopy. AJNR Am J Neuroradiol. 2002;23:882–8.PubMed

19.

Kreis R, Ernst T, Ross BD. Development of the human brain: in vivo quantification of metabolite and water content with proton magnetic resonance spectroscopy. Magn Reson Med. 1993;30:424–37.CrossRefPubMed

Title: Brain MRI and MR Spectroscopy Findings in Children with Nutritional Vitamin B12 Deficiency
Authors: F. Ekici, MD
G. Tekbas, MD
S. Hattapoğlu, MD
A. Yaramış, MD
H. Önder, MD
A. Bilici, MD
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Clinical Neuroradiology / Issue 2/2016
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-014-0351-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Brain MRI and MR Spectroscopy Findings in Children with Nutritional Vitamin B₁₂ Deficiency

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2016

Glycoprotein IIb/IIIa Inhibitor Bridging and Subsequent Endovascular Therapy in Vertebrobasilar Occlusion in 120 Patients

Laudatio

Spectrum and Prevalence of Pathological Intracranial Magnetic Resonance Imaging Findings in Acute Bacterial Meningitis

Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Carotid Elongation Does Not Affect Angiographic Results of Mechanical Thrombectomy in Acute Stroke

Treatment of a Giant Fusiform Basilar Aneurysm with Partial Intra-Aneurysmal Embolization Combined with Mid-Basilar Artery Occlusion in a Child