Abstract
We report a case of a 45-year-old gentleman presenting with numbness of both legs and hands. He has anemia, spastic quadriplegia with exageraterd tendon jerks with lose of vibration and position sense. Investigations revealed combined deficiency anemia with low serum vitamin B12. His MRI of cervicel spine was normal. Endoscopically he had atrophic gastritis. Ultimately he was dignosed as a case of sub-acute combined degeneration of spinal cord due to pernicious anemia. Patient was treated with injection vitamin B12 and well responded. On his followup, he had significant clinical improvement. This is a reversible condition if early diagnosis can be made and vitamin B12 therapy promptly given. Delayed treatment can result in irreversible neurological impairment.DOI: http://dx.doi.org/10.3329/jom.v14i1.14585 J MEDICINE 2013; 14 : 85-87
Highlights
Subacute combined degeneration is the classical metabolic disorder of spinal cord- it is due to vitamin B12 deficiency
Vitamin B12 deficiency can be caused by gastrointestinal malabsorption, defective intrinsic factor deficiency in gastric parietal cells,gastrectomy, pancreatic insuffiency, disease of terminal ilium,fish tapeworm infestation, poor nourishment of food, vegetarians, genetic deficiency of methylmalonyl-CoA mutase
Vitamin B12 deficiency state results in decreased activity of cobalamin-dependent methylcobalamin esterase enzyme with the resultant elevated levels of methylmalonic acid, which is toxic to myelin.Both myelin sheaths and axons, are destroyed mainly in the white matter of the spinal cord.[1, 2]
Summary
Subacute combined degeneration is the classical metabolic disorder of spinal cord- it is due to vitamin B12 deficiency. It can be caused by folate deficiency. He had anorexia, weight loss & sore mouth for 1 year. Weight loss & sore mouth for 1 year He had normal bladder-bowel function, no history of trauma to neck or neckache. Fig.-3: MRI of cervical spine showed normal finding. We concluded that this was a case of sub-acute combined degeneration of spinal cord due to Pernicious Anemia.
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