Can vitamin B12 deficiency manifest with acute posterolateral or posterior cord syndrome?

Vitamin B12 deficiency can cause varied neurological manifestations which are subacute to chronic in onset. Subacute combined degeneration of spinal cord is one such characteristic neurological manifestation of vitamin B12 deficiency. We report a case series of five patients who presented with acute onset (<15 days) neurological manifestations due to vitamin B12 deficiency. Detailed history and clinical examination along with appropriate relevant investigations were done in all patients. Out of the five, two cases were of useless hand syndrome due to involvement of posterior column of the cervical spinal cord, another two patients presented with acute posterolateral cord syndrome causing gait ataxia and one acute posterior cord syndrome presented with acute sensory gait ataxia. Laboratory investigations were compatible with the diagnosis of cobalamin deficiency in all cases. All cases improved after parenteral vitamin B12 supplementation. Vitamin B12 deficiency can present with acute neurological manifestations.