Abstract
The etiology of subacute combined degeneration (SCD) of the spinal cord is closely associated with vitamin B12 (VitB12) deficiency. The clinical manifestations of SCD are complex and vary substantially. Due to some SCD patients with atypical manifestations and concomitant autoimmune disorders, the probability of misdiagnosis and missed diagnosis is still relatively high in the early stage. We report the cases of two patients who were missed or misdiagnosed at another hospital because of the normal initial VitB12 level and partial overlap of clinical manifestations, finally diagnosed as SCD with atypical manifestations and concomitant autoimmune disorders, pharyngeal-cervical-brachial Guillain-Barre syndrome in Case 1 and SCD with autoimmune thyroiditis in Case 2. After undergoing corresponding treatment, death was reported in Case 1 and improvement in Case 2. Analysis of the clinical manifestations and investigation of the underlying pathogenesis in such patients could help improve the rate of early diagnosis and allow timely treatment of SCD, thereby preventing disease progression and poor clinical outcomes.
Highlights
Subacute combined degeneration (SCD) of the spinal cord is a rare disease characterized by demyelination of dorsal and lateral columns due to vitamin B12 (VitB12) deficiency
We have reported two rare cases of SCD with atypical manifestations and complicated with autoimmune disorders (Supplementary Table S1)
Wong summarized the diagnostic criteria for VitB12 deficiency [1]
Summary
Subacute combined degeneration (SCD) of the spinal cord is a rare disease characterized by demyelination of dorsal and lateral columns due to vitamin B12 (VitB12) deficiency. The patient was re-admitted to our department 1 month later due to worsening lower-limb weakness for 1 week. Re-examination showed VitB12 41000 pM and positive serum anti-intrinsic factor antibody. Predischarge examinations showed that deep sensations in the lower limbs had improved since the first hospitalization.
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Schedule a callMore From: Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
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