A 73-year-old woman comes to the physician because of a 2-month history of diffuse weakness and tingling of her arms and legs. Neurologic examination shows weakness of the extensor and flexor muscles of the lower extremities. Knee and ankle deep tendon reflexes are exaggerated. Sensation to vibration and position is decreased in all extremities, but the decrease is more prominent in the lower extremities than in the upper extremities. This patient most likely has a deficiency of which of the following vitamins?
(B) Vitamin B1 (thiamine)
(C) Vitamin B2 (riboflavin)
(D) Vitamin B6 (pyridoxine)
(E) Vitamin B12 (cyanocobalamin)
Correct answer : (E) Vitamin B12 (cyanocobalamin)
The clinical features are suggestive of Subacute Combined Degeneration of the Spinal Cord due to Vitamin B12 deficiency.