Subacute Combined Degeneration of the Cord

Subacute combined degeneration of the spinal cord is a neurologic complication of vitamin-B12 deficiency causing demyelination of the posterior columns and lateral corticospinal tracts. Clinical: distal symmetric paresthesias, loss of vibration/proprioception, sensory ataxia, upper-motor-neuron signs (spasticity, hyperreflexia), and sometimes cognitive changes. Associated with megaloblastic anemia. Treatment: prompt vitamin-B12 replacement to prevent irreversible deficit.

Common Symptoms

Distal paresthesia; loss of vibration/proprioception; sensory ataxia; spasticity; hyperreflexia; cognitive change; megaloblastic anemia

Causes and Pathogenesis

Vitamin-B12 deficiency impairs myelin synthesis (methylmalonyl-CoA accumulation), causing posterior/lateral-column demyelination; common in pernicious anemia/malabsorption/vegan diet.

Treatment

Parenteral vitamin-B12 replacement; treat underlying cause (pernicious anemia, malabsorption); folate only with B12

Preventive Measures

B12 supplementation in vegans/elderly; treat pernicious anemia; screen at-risk patients.

Department to Visit

It is recommended to visit the Neurology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.