Shaky-Leg Syndrome and Vitamin B 12 Deficiency

Abstract

A 68-year old man presented with a three-year history of trembling of the legs. The tremor began immediately after he stood and subsided when he began walking. His medical history was irrelevant to this problem. Neurologic examination showed a fine, rapid tremor of the legs that began immediately after the patient rose to the standing position and that abated on walking. Sensation of pain and heat was impaired in a stocking distribution, and the Achilles tendon reflexes were absent. Results of the rest of the examination were normal. Results of laboratory tests were remarkable only for a serum vitamin B 12 level of 132 ng per liter (normal range, 222 to 753). A Schilling test demonstrated malabsorption of vitamin B 12 . A computed tomographic scan of the bran was normal.