Case Presentation: A 32 year old male presented to the emergency department unresponsive. Three months prior he had developed urinary incontinence, cognitive impairments, paresthesias in his extremities and weakness requiring crutches. His symptoms progressed leaving him bed bound weeks prior to arrival. EMS was contacted when he became unresponsive to verbal-noxious stimuli and exhibited difficulty [...]

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 [...]