A Case of Subacute Combined Degeneration of Spinal Cord

Srinivasan VR, Murali Mohan Rao Vuda, Krishnaprasad A, Narendra AMVR, Lalith AV, Subhash Kaul

Department of Medicine, Department of Neurology

Nizam’s Institute of Medical Sciences Punjagutta, Hyderabad

A male aged 31, presented with memory impairment, erectile dysfunction of one month duration and unsteadiness of gait for two days. He had a history of anemia on irregular therapy. He was a vegetarian. He had mild pallor, glossitis, subtle impairment of recent of memory, normal fundi and cranial nerves, brisk tendon jerks, impairment of posterior column sensation and positive Rhomberg sign . Other systems were normal. Hemoglobin was 9 gm/dl, MCV 102.6 fL, TLC 5200, normal DC, platelet 2.1 Lakhs/µL and reticulocytes 0.5%. Bone marrow showed megaloblastosis and iron deficiency. S. B₁₂ was less than 60 pg/ml, folate was > 20 ng/mL, LDH was 974 IU/ml.

MRI cervical spine showed a demyelinated area in posterior columns. NCV was normal. SSEP was abnormal. Gastroscopy and biopsy were normal. Shilling test was not done. He improved rapidly with injections of Vit.B₁₂ and iron sulfate. After three months hemogram and neurologic status were normal. Nutritional cause of Vitamin B₁₂ deficiency with all its classical manifestation is emphasized in this case report.