Subacute combined degeneration of the spinal cord/Vitamin B12 Myelopathy
Metabolic disorder of spinal cord due to vitamin B12 deficiency – becoming rare now due to preparations of vitamin B12 for treatment of pernicious anaemia.
Pathologically – demyelination and vacuolar degeneration of posterior columns and corticospinal tracts.
Most asymptomatic. Symptoms of anaemia present. First sign is usually positive Babinski’s sign (plantar responses are extensor) – vibration sense also lost early. Progresses to distal paraesthesia (feet and hands), symmetrical sensory loss, loss of tendon reflexes (especially ankle).
Frequently associated with a peripheral neuropathy – glove and stocking sensory loss; most have reduced or loss of vibration sensation
Intramuscular B12; dietary therapy