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    Subacute combined degeneration

    Subacute combined degeneration of the spinal cord; SCD

    Subacute combined degeneration is a disorder of the spine, brain, and nerves. It involves weakness, abnormal sensations, mental problems, and vision difficulties.

    Causes

    Subacute combined degeneration is caused by a vitamin B12 deficiency. It mainly affects the spinal cord. But its effects on the brain and the peripheral (body) nerves are the reason for use of the term “combined.” At first, the covering of the nerves (myelin sheath) is damaged. Later, the entire nerve cell is affected.

    Doctors do not know exactly how a lack of vitamin B12 damages the nerves. It is possible the lack of this vitamin causes abnormal fatty acids to form around cells and nerves.

    A person has a high risk of this condition if vitamin B12 cannot be absorbed from the intestine or if a person has:

    • Pernicious anemia
    • Disorders of the small intestine, including Crohn's disease
    • Problems absorbing nutrients, which can occur after gastrointestinal surgery

    Symptoms

    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

    Exams and Tests

    The health care provider will perform a physical exam.The exam usually shows muscle weakness and sensationproblems on both sides of the body, especially in the legs. Knee jerk reflexes are often decreased. Muscles may develop spasticity.There may be reduced senses of touch, pain, and temperature.

    Mental changes range from mild forgetfulness to severe dementia or psychosis. 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 teststhat may be ordered include:

    Complete blood count (CBC)

    Vitamin B12 blood level

    Methylmalonic acid blood level

    Treatment

    Early treatment improves the chance of a good outcome.

    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.

    Outlook (Prognosis)

    How well a person does depends on how long they had symptoms before receiving treatment. If treatment is received within a few weeks, complete recovery may be expected. If treatment iss delayed for longer than 1 or 2 months, full recovery may not be possible.

    Untreated, the disorder results in progressive and irreversible damage to the nervous system.

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

    When to Contact a Medical Professional

    Call your health care provider if abnormal sensations, muscle weakness, or other symptoms of subacute combined degeneration develop. This is particularly important ifyou or a family member has had pernicious anemia or other risk factors.

    Prevention

    Some vegetarian diets may be low in vitamin B12. Taking a supplement can prevent the disorder.

    References

    Katri B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 76.

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    • Central nervous system

      illustration

      • Central nervous system

        illustration

      A Closer Look

        Tests for Subacute combined degeneration

          Review Date: 5/28/2013

          Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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