Visual Evoked Responses in Pernicious Anemia

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To the Editor.—  I was interested in reading the article by Troncoso et al relating to visual evoked responses (VERs) in pernicious anemia (36:168-169, 1979). Within one month in 1977, I had two patients with spinal cord lesions who proved to have subacute combined degeneration of the cord with low vitamin B₁₂ levels in the serum and positive Schilling's tests; both had abnormal evoked responses.

Report of Cases.—  Case 1.—A 51-year-old man had an 11-month history of weakness of his legs; he had had a transurethral resection one year earlier for apparent prostatism, but bladder symptoms had returned. He also had had a thyroidectomy 20 years earlier for thyrotoxicosis. Examination disclosed an almost entirely motor pyramidal syndrome; hemoglobin level was 13.5 g/dL; mean corpuscular volume (MCV), 103 cu μm; and vitamin B₁₂ level, 70 ng/L. Red blood cell folate concentration was normal at 318 μg/L.The VERs showed the major