Introduction: Vitamin B12 deficiency can affect all age groups. This can present with varying neurological Manifestataions apart form heamatological and skin changes. This case series study is presented with an aim to identify the diverse clinical manifestations. Materials and methods: Patients admitted in neurology department government general hospital with neurological manifestations attributable to Vitamin B12 deficiency and reduced Vitamin B12 levels were taken and analysed. Results: The dietary differences was not the sole or significant influencing factor. Myeloneuropathy was seen in 80% with posterior column and pyramidal signs. Cognitive signs, psychiatric features, cerebellar, extrapyramidal features, urinary urgency, optic atrophy were seen in few patients. Discussion: The most common presentation had been myeloneuropathy with posterior column and pyramidal signs. 26.66% had pyramidal signs in lower limb alone, remaining had in upper and lower limbs with earlier involvement in thoracic portion of the spinal cord. The atypical features like cerebellar, extrapyramidal features have been observed in previous studies. Conclusion: Vitamin B12 deficiency to be suspected when confronted with any of the neurological manifestations even in an atypical presentation with any atypical features with pyramidal signs even without significant posterior column signs or neuropathy.

Keywords: Vitamin B12 Deficiency; Subacute Combined Degeneration; Myeloneuropathy.