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SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD

Neurology

SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD

1. B 12 deficiency causes segmental loss of myelin in the dorsal and lateral columns.

2. Clinical - gradual weakness associated with paresthesias and loss of proprioception with development of ataxia.

3. Severe cases end in extensive bilateral lower extremity weakness, spasticity, and urinary incontinence +/- cognitive impairment.

4. Cognitive changes include progressively worsening confusion, apathy, delusions, paranoia.

5. Think of B 12 deficiency in a patient with brisk knee jerks (due to pyramidal tract dysfunction) and absent ankle jerks (due to peripheral neuropathy).

6. Diagnose by measuring serum B1z, methylmalonic acid (MMA), and homocysteine (HC) levels. In states of B12 deficiency, both MMA and HC are increased.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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