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David Martin, MD
St Paul-Ramsey Medical Center St Paul

JAMA. 1982;247(1):28.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Soon after the case reports appeared by Butler et al describing Lhermitte's sign as an early finding of cobalamin deficiency (1981;245:1059), a 77-year-old man came to our geriatric clinic complaining of "electric shock-like" dysesthesias in both upper extremities. The maneuver most likely to precipitate the dysesthesis was forward flexion of the head while using the upper extremities.

A physical examination with special attention to the posterior column function was unremarkable. The patient's hemoglobin level was 13.5 g/ dL, and the mean corpuscular volume was 102 femtoliters. There was no hypersegmentation of polymorphonuclear cells. The serum cobalamin level was depressed at 84 pg/dL (normal, 120 to 270 pg/dL), and a repeated test confirmed that the patient's level was well below the 95% confidence limit for the test. A Schilling's test showed normal absorption of crystalline cyanocobalamin Co 57. Treatment with parenterally administered cyanocobalamin alleviated the patient's symptoms.

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