Definition:
Subacute combined degeneration of the spinal cord ( SCD ) - is a systemic spongy vacuolation and myelin degeneration due to vitamin B12 deficiency.
Typical is the involvement of the posterior and lateral columns of the spinal cord in the cervical and thoracic parts of the spinal cord.
Epidemiology:
Prevalence of Subacute combined degeneration of the spinal cord is estimated in the range from 4.8% to 12% among the elderly.
More frequently,
the disease is diagnosed in 50 - 80 years.
About 50% of patients with malignant anemia have subclinical manifestations of SCD,
with about 25% of patients with SCD who are not aware of attendant anemia.
Etiology:
- Inadequate intake from food (vegetarians)
- Lack or insufficient function of the Intrinsic factor (malignant anemia)
- Hypochlorhydria (partial or total gastrectomy)
- Insufficiency of vitamin B12 absorption at the colon (after removal of the part of the intestine,
Crohn's disease)
- Other causes - poisoning with nitrous oxide,
insufficiency of copper,
folic acid,
HIV infection.
Clinical presentation:
1) Dysfunction of dorsal columns of the spinal cord (loss of vibration sensitivity and joint position sense,
ataxia).
2) Dysfunction of lateral corticospinal tracts (hyperreflexia,
spasticity)
3) Dysfunction of spinotalamic pathways (sensory loss).
Treatment of vitamin deficiency is long,
with multiple injections of the vitamin B12 preparation are applied,
and subsequent slow regress of the clinic and neuroradiologic symptoms.