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
Nizamís Institute of Medical Sciences Punjagutta,
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/ĶL and††
reticulocytes 0.5%.† Bone marrow showed megaloblastosis
and iron deficiency.
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.