Subacute combined degeneration of the spinal cord and air encephalography (original) (raw)
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Subacute Combined Degeneration of the Spinal Cord
BMJ, 1959
Subacute combined degeneration (SCD) is a rare neurological complication of vitamin B12 deficiency, characterized by demyelination of the dorsal and lateral spinal cord. Herein, we describe three cases, who presented with SCD, one related to reduced intake of vitamin B12 because of a vegetarian diet and two related to nitrous oxide exposure during surgery. MR images of our patients revealed symmetrical hyperintense signals in dorsal and lateral columns in T2 weighted series. After treatment with intramuscular B12 injections (1 mg daily for 2 weeks, once weekly thereafter for three months) all patients showed improvement of their symptoms. Abnormalities of the spinal cord on MRI resolved in three months. In conclusion, SCD either due to nitrous oxide exposure or due to reduced intake of vitamin B12 is a reversible condition, when detected and treated early.
Subacute Combined Degeneration of the Spinal Cord in a Child
Indian Journal of Pediatrics, 2011
Subacute combined degeneration (SCD) is a rare neurological complication of vitamin B12 deficiency, characterized by demyelination of the dorsal and lateral spinal cord. Herein, we describe three cases, who presented with SCD, one related to reduced intake of vitamin B12 because of a vegetarian diet and two related to nitrous oxide exposure during surgery. MR images of our patients revealed symmetrical hyperintense signals in dorsal and lateral columns in T2 weighted series. After treatment with intramuscular B12 injections (1 mg daily for 2 weeks, once weekly thereafter for three months) all patients showed improvement of their symptoms. Abnormalities of the spinal cord on MRI resolved in three months. In conclusion, SCD either due to nitrous oxide exposure or due to reduced intake of vitamin B12 is a reversible condition, when detected and treated early.
Case reports in neurological medicine, 2013
Subacute combined degeneration (SCD) is a rare neurological complication of vitamin B12 deficiency, characterized by demyelination of the dorsal and lateral spinal cord. Herein, we describe three cases, who presented with SCD, one related to reduced intake of vitamin B12 because of a vegetarian diet and two related to nitrous oxide exposure during surgery. MR images of our patients revealed symmetrical hyperintense signals in dorsal and lateral columns in T2 weighted series. After treatment with intramuscular B12 injections (1 mg daily for 2 weeks, once weekly thereafter for three months) all patients showed improvement of their symptoms. Abnormalities of the spinal cord on MRI resolved in three months. In conclusion, SCD either due to nitrous oxide exposure or due to reduced intake of vitamin B12 is a reversible condition, when detected and treated early.
A Case of Subacute Combined Degeneration as a Manifestation of Pernicious Anaemia
European Medical Journal Neurology, 2021
Vitamin B 12 deficiency affects multiple systems, including the central and peripheral nervous systems, producing a vast spectrum of neurological symptoms. It is particularly important due to its insidious presentation and because it can evolve to spastic paraplegia with permanent sequelae. The authors describe a case of a woman with asthenia, bilateral lower limb weakness, urinary retention, and faecal incontinence, with no structural cause on imaging studies. Blood tests showed anaemia (haemoglobin: 6.8 g/dL) and vitamin B 12 deficiency (<100 pg/mL). After upper digestive endoscopy compatible with chronic atrophic gastritis and positive for anti-intrinsic factor antibodies was obtained, the diagnosis of subacute combined degeneration due to vitamin B 12 deficiency in the context of pernicious anaemia was admitted. Although this entity is a rare cause of myelopathy, it is a frequent manifestation of vitamin B 12 deficiency. Clinical suspicion is fundamental since the reversibility of the neurological lesion is dependent on early treatment.
Journal of Psychology & Psychotherapy, 2015
Vitamin B12 or cynacobalamin is an important water soluble vitamin which plays a key role in erythropoiesis, proper nervous system functioning and for the metabolism of carbohydrate, fat and protein. Patients with cynacobalamin deficiency may present with haematological, gastro-intestinal, oral, dermatological, psychiatric and neurological disturbances. We present a case of sub-acute combined degeneration (SACD) of spinal cord in a fortynine year old female presenting with one month history of progressive symptoms of lower limb paraesthesia, sensory deficit, psychotic symptoms and postural instability. This case report is unusual as it elucidates the characteristic triad, i.e., haematological, psychiatric and neurological symptoms in sub-acute combined degeneration of spinal cord (SACD) associated with B12 deficiency, correlation of its clinical manifestations, electrophysiological signs, laboratory investigations (especially biomarkers of B12 status) and spinal magnetic resonance (MR) imaging in establishing the diagnosis, treatment outcomes, and potential therapeutic relevance of vitamin B12 replacement therapy in symptoms remission.
B12 deficiency with neurological manifestations in the absence of anaemia
BMC Research Notes, 2015
Background: Vitamin B 12 deficiency is often diagnosed with hematological manifestations of megaloblastic macrocytic anemia, which is usually the initial presentation. Neurological symptoms are often considered to be late manifestations and usually occur after the onset of anemia. Sub acute combined cord degeneration, which is a rare cause of myelopathy is however the commonest neurological manifestation of vitamin B 12 deficiency. Case presentation: We present a case of a 66 year old Sinhalese Sri Lankan female, who is a strict vegetarian, presenting with one month's history suggestive of Sub-acute combined cord degeneration in the absence of haematological manifestations of anaemia. Her Serum B 12 levels were significantly low, after which she was treated with hydroxycobalamine supplementation, showing marked clinical improvement of symptoms, with normalization of serum B 12 levels. Hence, the diagnosis of vitamin B 12 deficiency was confirmed retrospectively. Conclusion: Vitamin B 12 deficiency could rarely present with neurological manifestations in the absence of anaemia. Therefore a high index of suspicion is necessary for the early diagnosis and prompt treatment in order to reverse neurological manifestations, as the response to treatment is inversely proportionate to the severity and duration of the disease.
Reversible myelopathy with vitamin B12 deficiency
Vitamin B12 defiiency causes haematological, gastrointestinal, psychiatric and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord, characterised by degeneration of the lateral and posterior columns, is often found due to vitamin B12 defiiency. We report SCD occurring in a 57-year-old man who presented with a 2.5–month history of gradually progressing tingling in the figers and toes and neck ache. Laboratory data revealed vitamin B12 defiiency and magnetic resonance (MR) imaging of the cervical spinal cord demonstrated abnormal hyperintense signal changes on T2- weighted imaging of the posterior columns. In our case, follow-up MR imaging fidings correlated well with clinical outcome after treatment with vitamin B12 supplements. Neurological symptoms in vitamin B12 defiiency are frequent. Early spinal MR imaging assists in the early diagnosis and treatment of the disease.
European Journal of Internal Medicine, 2008
Sub-acute combined degeneration (SCD) is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication due to vitamin B12 deficiency. Revealing forms of SCD without anemia are rare. We report a case of SCD of the spinal cord in a 33-year-old woman without anemia but with a 10-month history of paresthesis and urine imperiosity. Magnetic resonance imaging (MRI) of the spine showed intramedullary hyperintensity seen on T2-weighted images in the posterior column of the cervico-dorsal spinal cord, extending from C1 to D1. A diagnosis of SCD of the spinal cord was considered and confirmed by a low serum cobalamin. The patient was treated with vitamin B12 supplements and showed gradual improvement in her clinical symptoms.
Can vitamin B12 deficiency manifest with acute posterolateral or posterior cord syndrome?
Spinal Cord Series and Cases, 2016
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 (o15 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.