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a Department of Neurology, b Department of
Neuroradiology, University of Freiburg, Breisacher Stra
e 64, D-79106
Freiburg, Germany, c Department of
Neurology, University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
Correspondence to: Dr F X Glocker, Department of Neurology, University of Freiburg, Breisacher Straße 64, D-79106 Freiburg, Germany. Telephone 0049 761 270 5313; fax 0049 761 270 5313.
Received 13 January 1998 and in revised form 20 April 1998;
Accepted 20 April 1998
OBJECTIVE
Vitamin B12 deficiency is a
systemic disease that often affects the nervous system. One of the most
prevalent manifestations is subacute combined degeneration (SCD) of the
spinal cord. To access the clinical, electrophysiological, and
structural abnormalities associated with SCD, a study was conducted in
nine patients.
METHODSClinical, electrophysiological
(electroneurography, somatosensory and motor evoked potentials), and
MRI evaluations were performed in patients before and after treatment.
RESULTSThe most prominent clinical and
electrophysiological findings in all patients were dysfunctions of the
posterior column. Corresponding hyperintense lesions in the posterior
column of the spinal cord were found in two patients by T2 weighted
MRI. Damage to the central motor pathway was identified in four
patients. Demyelinating neuropathy was present in one patient and
axonal neuropathy in four. All patients showed improvement of their
symptoms after treatment with cobalamin. Abnormalities of the spinal
cord on MRI disappeared early in recovery. Motor evoked potentials and
median somatosensory evoked potentials typically normalised after
treatment, whereas tibial somatosensory evoked potentials remained
abnormal in most patients.
CONCLUSIONSClinical, electrophysiological, and
MRI findings associated with SCD in vitamin B12 deficiency
are diverse. Thus vitamin B12 deficiency should be
considered in the differential diagnosis of all spinal cord, peripheral
nerve, and neuropsychiatric disorders.
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