Sequential Involvement of the Nervous System in Subacute Combined Degeneration.
10.3349/ymj.2012.53.2.276
- Author:
Yang Ki MINN
1
;
Seung Min KIM
;
Se Hoon KIM
;
Ki Han KWON
;
Il Nam SUNWOO
Author Information
1. Department of Neurology, College of Medicine, Hallym University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Vitamin B12;
subacute combined degeneration;
spinal cord;
somatosensory evoked potential;
nisual evoked potential
- MeSH:
Adolescent;
Adult;
Aged;
Aged, 80 and over;
Evoked Potentials, Somatosensory/physiology;
Female;
Humans;
Male;
Middle Aged;
Subacute Combined Degeneration/*blood/metabolism/*physiopathology;
Vitamin B 12/blood;
Vitamin B 12 Deficiency/blood/complications;
Young Adult
- From:Yonsei Medical Journal
2012;53(2):276-278
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Subacute combined degeneration (SCD) involves progressive degeneration of the spinal cord, optic nerve, and peripheral nerves. Vitamin B12 (VB12) is a co-factor in myelin synthesis. Because each cell that constitutes the myelin component in the central nervous system and peripheral nervous system is different, it is improbable that these cells undergo simultaneous degeneration. However, the sequence of degeneration in SCD has not been established. MATERIALS AND METHODS: In this study, we analysed medical records and electrophysiological data of patients who showed neurological symptoms and whose serum VB12 levels were lower than 200 pg/mL. RESULTS: We enrolled 49 patients in this study. Their mean VB12 level was 68.3 pg/mL. Somatosensory evoked potential (SEP) study showed abnormal findings in 38 patients. Of the 40 patients who underwent visual evoked potential (VEP) study, 14 showed abnormal responses. Eighteen patients showed abnormal findings on a nerve conduction study (NCS). In this study, abnormal posterior tibial nerve SEPs only were seen in 16 patients, median nerve SEPs only were seen in 3 patients, abnormal VEPs only in two, and abnormal NCS responses in one patient. No patient complained of cognitive symptoms. CONCLUSION: In SCD, degeneration appears to progress in the following order: lower spinal cord, cervical spinal cord, peripheral nerve/optic nerve, and finally, the brain.
