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Experts suggest that the polyneuropathy sometimes present in patients with [B.sub.12] deficiency due to gastrointestinal malabsorption and/or gastric bypass surgery may be secondary to concurrent nutritional deficiencies (e.g., copper, pyridoxine), and pure cobalamin deficiency causes an encephalomyelopathy but not an encephalomyeloneuropathy (1).
We suspect that the tetanus portion of the vaccination produced TM in our patient because vaccination with tetanus toxoid has been mainly associated with neurological side effects such as recurrent episodes of Guillain-Barre syndrome (GBS), brachial neuritis, peripheral neuropathy, encephalomyeloneuropathy and TM (17-22).
Isolation and characterization of HTLV-I from symptomatic family members with tropical spastic paraparesis (HTLV-I encephalomyeloneuropathy).

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