Analysis of clinical characteristics of subacute combined degeneration on three cases of delayed diagnosis

Abstract

Purpose: Subacute Combined Degeneration (SCD) is a kind of neurodegenerative diseases which is easy to be misdiagnosed because of some promiscuous symptoms and atypical laboratory test results. The prognosis would be poor if patients had clinical symptoms of myelopathy for a long time. Therefore, doctors should combine pre-existing conditions, clinical symptoms and correlated laboratory examinations to make definite diagnosis quickly and accurately. Case report: Three middle-aged patients aged from 41 to 63, one male and two females were diagnosed SCD with progressive ascending numbness in four limbs or both legs. For some reason, none of them got the right diagnosis in the first place. In case 1, blood cell analysis revealed a decrease in three series including white blood cells, platelets and hemoglobin. In case 2, the blood cell analysis of the patient did not show signs of anemia at all. While the initial clinical symptom in case 3 was just a mild psychiatric symptom. Although their final diagnosis were clear, the failure not to take SCD into consideration at the first time was worthy of reflection. Fortunately, their neurological status improved after vitamin B12 supplementation. Conclusion: Usually, some confusing symptoms and a typical laboratory may make SCD easy to be misdiagnosed. Early diagnosis and treatment are critical to the prognosis. Thus, the clinicians must capture the related clinical characteristics. Keywords: subacute combined degeneration; vitamin b12 deficiency; clinical characteristics.