Vitamin B₁₂ deficiency presenting as neck pain and cervical radiculopathy

Vitamin B₁₂ is required for the formation of haematopoietic cells and the synthesis of myelin. Deficiency typically presents with fatigue and megaloblastic anaemia. Prolonged deficiency can cause neurological symptoms such as paresthesia, which can progress to subacute combined degeneration of the spinal cord. We describe an unusual presentation of B₁₂ deficiency in a young man who was initially diagnosed and treated for cervical radiculopathy. This case highlights the challenges of diagnosing B₁₂ deficiency in patients with neurologic but without haematologic, abnormalities. While the current incidence of B₁₂ deficiency in developed countries is low, cases are likely to rise with the increased adoption of veganism. Clinicians should be aware of the variable presentations of B₁₂ deficiency because delayed diagnosis and treatment increases morbidity and can cause irreversible neurological deficits.