Subacute combined degeneration of spinal cord

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Subacute combined degeneration of spinal cord

Classification and external resources

Diagram of the principal fasciculi of the spinal cord. (In subacute combined degeneration of spinal cord, the "combined" refers to the fact that the dorsal columns and lateral corticospinal tracts are both affected, in contrast to tabes dorsalis which is selective for the dorsal columns.)

ICD-10

G32.0 , E53.8

ICD-9

336.2 , 266.2

DiseasesDB

12591

MedlinePlus

000723

MeSH

D052879

Subacute combined degeneration of spinal cord, also known as Lichtheim's disease,[1][2]refers to degeneration of the posterior and lateral columns of the spinal cord as a result ofvitamin B12 deficiency (most common), vitamin E deficiency or Friedrich's ataxia. It is usually associated with pernicious anemia.
Contents
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1 Presentation 2 Treatment 3 References 4 External links

[edit]Presentation
The pathological findings of subacute combined degeneration consist of patchy losses of myelinin the dorsal and lateral columns. Patients present with weakness of legs, arms, trunk, tingling and numbness that progressively worsens. Vision changes and change of mental state may also be present. Bilateral spastic paresis may develop and pressure, vibration and touch sense are diminished. A positive Babinski sign may be seen. Prolonged deficiency of vitamin B12 leads to irreversible nervous system damage. If someone is deficient in vitamin B12 and folic acid, the vitamin B12 deficiency must be treated first to avoid precipitating subacute combined degeneration of the cord.

[edit]Treatment
Therapy with vitamin B12 results in partial to full recovery, depending on the duration and extent of neurodegeneration.

Subacute Combined Degeneration

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Overview
Alternative Names Causes Symptoms Exams and Tests Treatment Outlook (Prognosis) Possible Complications When to Contact a Medical Professional Prevention References

Related Topics
Vitamin B12 Weakness Numbness and Tingling Vision Problems Pernicious Anemia Crohn's Disease Malabsorption

Illustrations

Central Nervous System and Peripheral Nervous System

Subacute combined degeneration is a disorder of the spine, brain, and nerves that involves weakness, abnormal sensations, mental problems, and vision difficulties.
REFERENCE FROM A.D.A.M.
Back to TopAlternative

Names

Subacute combined degeneration of the spinal cord; SCD

Back to TopCauses

Subacute combined degeneration of the spinal cord is caused by a vitamin B12 deficiency. (For specific information on vitamin B12 deficiency, see the article on pernicious anemia.) Subacute combined degeneration primarily affects the spinal cord but its effects on the brain and the peripheral (body) nerves are the reason for the term combined. At first, the disease damages the covering of the nerves (the myelin sheath). It later affects the entire nerve cell. How a lack of vitamin B12 damages nerves is unclear. However, experts believe the lack of this vitamin causes abnormal fatty acids to form around cells and nerves. You have a higher risk for this condition if you cannot absorb vitamin B12 from the intestines or if you have:

Pernicious anemia Disorders of the small intestine, including Crohn's disease Malabsorptive conditions, which can occur after gastrointestinal surgery
Back to TopSymptoms

Symptoms include:

Abnormal sensations (tingling and numbness) Weakness of the legs, arms, or other areas These symptoms slowly get worse and are usually felt on both sides of the body. Other symptoms include:

Clumsiness, stiff, or awkward movements Change in mental state such as memory problems, irritability,apathy, confusion, or dementia Decreased vision Depression Sleepiness Unsteady gait and loss of balance

Back to TopExams

and Tests

The health care provider will perform a physical exam. An exam usually shows muscle weakness and sensation disturbances on both sides of the body, especially in the legs. Reflexes are often abnormal. Muscles may develop spasticity. You may have a reduced sense of touch, pain, and temperature. Mental changes range from mild forgetfulness to severe dementia orpsychosis. Severe dementia is uncommon, but in some cases, it is the first symptom of the disorder. An eye exam may show damage to the optic nerve, a condition called optic neuritis. Signs of nerve inflammation may be seen during a retinal exam. There may also be abnormal pupil responses,decreased visual acuity, and other changes. Blood tests, including a complete blood count (CBC), vitamin B12 blood level, or methylmalonic acid blood level are used to diagnose anemia or vitamin B12 deficiency.
Back to TopTreatment

Early treatment improves the chances of a good outcome, so the disease should be treated promptly. Vitamin B12 is given, usually by injection into a muscle. Injections are often given once a day for a week, then weekly for about 1 month, and then monthly. Vitamin B12 supplements either by injection or high dose pills must continue throughout life to prevent symptoms from returning.
Back to TopOutlook

(Prognosis)

How well a person does depends on how long they had symptoms before receiving treatment. If treatment was received within a few weeks, complete recovery usually occurs. If treatment was delayed for longer than 1 or 2 months, recovery isn't as complete. If you had symptoms for many months without receiving medical care, treatment may slow or stop your symptoms, but it is unlikely that you will recover function that you have already lost. Any symptom improvement occurs within a year of treatment. Untreated, the disorder results in progressive and irreversible damage to the nervous system.
Back to TopPossible

Complications

Complications can include permanent, progressive loss of nerve and mental functions.
Back to TopWhen

to Contact a Medical Professional

Call your health care provider if abnormal sensations, muscle weakness, or other symptoms of subacute combined degeneration develop, particularly if there is a personal or family history of pernicious anemia or other risk factors. Early diagnosis and treatment improve the chance of a good outcome.
Back to TopPrevention

Some strict vegetarian diets may be low on vitamin B12 and supplementation can prevent the disorder.