Question

The wife of a 67-year-old man brings him for evaluation. He is mildly disoriented, has facial tremors, an enlarged liver, and an enlarged beefy tongue. On neurologic exam, his gait is unsteady, especially when the lights are lowered. Tactile sensation is decreased, especially in the legs, and he has generalized weakness with spasticity and increased reflexes. Most likely diagnosis?

A. Neurosyphilis
B. Pernicious anemia - vitamin B12 deficiency
C. Multiple sclerosis
D. Cerebellar degeneration from alcoholism
E. Multi-infarct vascular disease

Answer 1

The most likely diagnosis for the patient's symptoms is pernicious anemia - vitamin B12 deficiency, which can lead to neurological manifestations such as tremors, ataxia, peripheral neuropathy, and weakness.

Step-by-step explanation:

The most likely diagnosis for the 67-year-old man with mild disorientation, facial tremors, enlarged liver, enlarged tongue, unsteady gait, decreased tactile sensation, generalized weakness, spasticity, and increased reflexes is B. Pernicious anemia - vitamin B12 deficiency. Vitamin B12 deficiency can result in neurological symptoms such as cognitive impairment, tremors, ataxia, peripheral neuropathy, and weakness. The enlarged liver and tongue, as well as the sensory deficits and spasticity, are consistent with the neurological manifestations of vitamin B12 deficiency.