On April 21, Dr Sudhir Kumar, a neurologist at Apollo Hospital in Hyderabad, who goes by the handle Hyderabad Doctor on X, shared a puzzling case of a woman who fainted whenever she washed her face. Dr Sudhir tried to solve the medical anomaly in a post he shared on X.
According to the neurologist, the woman was a healthy, 40-year-old individual who walked normally in daylight and had no weakness in her legs. However, every time she tried to wash her face or walk at night with the lights off, she lost her balance. Also Read | Is rubbing banana peel on the skin a natural Botox alternative? Maryland doctor explains
“She walks 5 km every morning. But nearly falls… while washing her face. A clinical puzzle: A 40-year-old woman walks normally in daylight, and has no weakness of legs. But she loses her balance while washing her face and while walking at night (with the lights off). What is the diagnosis?” Dr Sudhir wrote in the post.
Why does a healthy woman lose balance in the dark?
Sharing the mysterious case of the woman on social media, Dr Sudhir suggested that her issue could be linked to four ailments, including cerebellar ataxia, vestibular disorder, vitamin B12 deficiency, and functional gait disorder. However, per the neurologist, only one of these was the real problem.
Explaining the main cause of this medical anomaly, Dr Sudhir noted that the clue lies in the woman’s medical history. According to him, if the woman could walk normally with her eyes open and was only imbalanced when her vision was removed, it means she has a vitamin B12 deficiency.
He elaborated, “This is sensory ataxia due to involvement of the posterior columns. Vision compensates during the day. Remove vision, and the patient becomes unsteady. This is the clinical equivalent of a classic Romberg positive. Most common cause? Vitamin B12 deficiency.”
“Take-home: Walks fine in light, unstable in dark is suggestive of a posterior column problem. Check for vitamin B12 deficiency,” he further added.
Vitamin B12 deficiency, sensory ataxia and a positive Romberg test explained
For the uninitiated, according to Physiopedia, a Romberg test is positive when the patient is unable to maintain balance with their eyes closed. Meanwhile, sensory ataxia is a form of ataxia caused by the impairment of the somatosensory nerves, leading to the interruption of sensory feedback signals. It is characterised by postural instability and lack of coordination that worsen when visual input is removed.
Meanwhile, the NHS says that a vitamin B12 deficiency should be treated as early as possible, as it can also cause symptoms that affect your brain and nervous system (neurological symptoms), including numbness, muscle weakness, and psychological problems, which can range from mild depression or anxiety to confusion and dementia.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
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