Reversible Dementia and Neuropathy Associated with Folate Deficiency 16 Years After Partial Gastrectomy

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Abstract
A 57 yr old woman developed dementia and peripheral neuropathy 16 yr after a partial gastrectomy (Billroth II). Serum cobalamin was 198 pmol/l (reference interval 150-550), and the vitamin B12 absorption test (Schilling) showed decreased absorption (1.7% without and 2.2% with intrinsic factor). In spite of 20 mo. therapy with vitamin B12, the neurological symptoms progressed. Folate deficiency was suggested by a vey low erythrocyte folate and a slightly abnormal FIGLU [formininoglutamic acid] test. There were no other signs of general malabsorption. A few months'' treatment with folic acid significantly improved the massive neurological manifestations which were verified neurophysiologically and histologically. A common role of vitamin B12 and folate in the development of neuropathy is suggested.