Subacute combined degeneration of the spinal cord is a neurological condition caused by vitamin B12 deficiency that results in demyelination of the spinal cord. It presents with numbness and weakness in the extremities and an unsteady gait. Examination reveals sensory ataxia, diminished distal motor strength, and loss of vibration and joint position sense in the lower limbs. Diagnosis is based on signs and symptoms along with low vitamin B12 levels and megaloblastic anemia. Prompt treatment with high dose vitamin B12 injections can lead to complete recovery if diagnosed early, but established cases only halt progression.
Subacute combined degeneration of the spinal cord is a neurological condition caused by vitamin B12 deficiency that results in demyelination of the spinal cord. It presents with numbness and weakness in the extremities and an unsteady gait. Examination reveals sensory ataxia, diminished distal motor strength, and loss of vibration and joint position sense in the lower limbs. Diagnosis is based on signs and symptoms along with low vitamin B12 levels and megaloblastic anemia. Prompt treatment with high dose vitamin B12 injections can lead to complete recovery if diagnosed early, but established cases only halt progression.
Subacute combined degeneration of the spinal cord is a neurological condition caused by vitamin B12 deficiency that results in demyelination of the spinal cord. It presents with numbness and weakness in the extremities and an unsteady gait. Examination reveals sensory ataxia, diminished distal motor strength, and loss of vibration and joint position sense in the lower limbs. Diagnosis is based on signs and symptoms along with low vitamin B12 levels and megaloblastic anemia. Prompt treatment with high dose vitamin B12 injections can lead to complete recovery if diagnosed early, but established cases only halt progression.
Subacute combined degeneration of the spinal cord is a neurological condition caused by vitamin B12 deficiency that results in demyelination of the spinal cord. It presents with numbness and weakness in the extremities and an unsteady gait. Examination reveals sensory ataxia, diminished distal motor strength, and loss of vibration and joint position sense in the lower limbs. Diagnosis is based on signs and symptoms along with low vitamin B12 levels and megaloblastic anemia. Prompt treatment with high dose vitamin B12 injections can lead to complete recovery if diagnosed early, but established cases only halt progression.
COMBINED DEGENERATION OF CORD WHAT IS SCDC?? ◦ It is a selective disorder of spinal cord resulting from vitamin B12 deficiency. CAUSES ◦ Impaired absorption due to lack of intrinsic factor(Idiopathic) ◦ Following partial or total gastrectomy or gastrojejunostomy. ◦ Gastric malignancy ◦ Coeliac disease ◦ Chronic Pancreatic insufficiency VITAMIN B 12 DEFICIENCY PATHOLOGY: ◦ Spinal cord demyelination with eventual loss of axon. ◦ Affects posterior columns and lateral columns. ◦ Mainly corticospinal tract and spinocerebellar tracts are affected, ◦ CORTICOSPINAL DGENERATION LOWER CORD ◦ POSTERIOR COLUMN DEGENERATION UPPER CORD ◦ Peripheral nerve large myelinated fiber degeneration also occurs. ◦ Vitamin B 12 deficiency resulting in neurological damage is usually associated with megaloblastic anemia,though a normal peripheral blood film may be found. ◦ Vitamin B12 deficiency results in formation and accumulation of abnormal fatty acids with defective choline and phospholipids within the nervous system. CLINICAL FEATURES: ◦ Onset is subacute ◦ Parasthesias of extremities is the presenting symptom ◦ Numbness and distal weakness follow. ◦ Walking becomes unsteady. ◦ Spasticity is evident in the lower limb with flexor or extensor spasms. OTHER NEUROLOGICAL SYMPTOMS: ◦ Optic atrophy ◦ Cerebral demyelination ◦ Encephalopathy ◦ Dementia EXAMINATION Gait is ATAXIC. POSITIVE ROMBERG TEST-SENSORY ATAXIA. Motor power is diminished distally. Extensor plantar response.
SENSORY ATAXIC GAIT SENSORY DISTURBANCES: Vibration,joint position sense is lost in lower limb. Glove and stocking Anesthesia is found when peripheral nerves also get involved. ◦ Reflex finding:Variable and depend upon peripheral nerve or corticospinal tract involvement. ◦ Mini mental scale examination-Dementia ◦ Optic pallor:may be seen. DIAGNOSIS ◦ Suspect in paraparesis with combined upper and lower motor neuron signs. ◦ Glove and stocking type Anesthesia. ◦ Differentiate from other causes of Acute myelopathy:Cord compression and Multiple sclerosis. INVESTIGATIONS: ◦ Peripheral blood film-Megaloblastic anemia ◦ Serum Vitamin B12-less than 100 pg ◦ Bone marrow:Megaloblastic erythropoiesis. MRI: High signal intensity on T2 W images of spinal cord.
; TREATMENT ◦ NEUROLOGICAL DYSFUNCTION PRESENT
◦ START VITAMIN B12 PROMPTLY-1000microgram daily for several
weeks and months thereafter. COURSE AND PROGRESSION ◦ If diagnosed and treated early within 2 months of onset
◦ Complete recovery is possible
◦ In established cases
◦ Only progression is halted
◦ Untreated cases
◦ Progressive disease and patient becomes bed bound or
