Case Presentation: A 40 year-old female presented to the Emergency Department with several months of fatigue followed by acute fever and confusion. She denied weight loss, swollen glands, cough, rash, arthralgias, or myalgias. No drug or alcohol use. She was febrile to 102.5F. The remainder of the vital signs were normal, and the neuro exam [...]

Case Presentation: A 49-year-old vegetarian male (on supplements with vitamin B12) with recent myocardial infarction (MI) presented with 8-months of worsening neurological symptoms beginning as paresthesias progressing to cognitive decline and gait instability. Physical exam was significant for poor recall, inability to perform basic calculations, impaired proprioception in the right lower extremity, sensory ataxia in [...]