Subacute combined degeneration is the clinical syndrome associated with vitamin B12 deficiency and characterized by usually symmetrical weakness and progressively worsening of, and abnormal sensations of the legs, arms, trunk, or other area, mental abnormalities, and vision difficulties. Subacute combined degeneration primarily affects the spinal cord, but it also includes damage to the brain, the nerves of the eye, and the peripheral (body) nerves. In this study, we report two patients with subacute combined degeneration of the cord in association with folate deficiency. Subacute combined degeneration of the spinal cord and optic atrophy occurred only in the patients with vitamin B12 deficiency. However, diet-induced folic acid deficiency and subacute combined degeneration of the spinal cord which improved significantly after treatment with folic acid has been recorded.
Arm ; Brain ; Folic Acid Deficiency ; Folic Acid* ; Humans ; Leg ; Optic Atrophy ; Sensation ; Spinal Cord ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency

Adult ; Aged ; Alcohol Drinking ; epidemiology ; China ; epidemiology ; Cities ; epidemiology ; Female ; Folic Acid Deficiency ; epidemiology ; Humans ; Hyperhomocysteinemia ; epidemiology ; Male ; Middle Aged ; Prevalence ; Smoking ; epidemiology ; Vitamin B 12 Deficiency ; epidemiology

Subacute combined degeneration is a disease of spinal cord involving the posterior and lateral columns due to vitamin B12 deficiency. We experienced a 56-year-old man suffering subacute combined degeneration, characterised by dysesthesia and disturbance of deep sensation such as position sense, proprioception and vibration sense in the lower extremities, and ataxic gait. We reported one patient with subacute combined degeneration of the cord in association with pernicious anemia resulting from inactivation of intrinsic factor by it's antibodies.
Anemia, Pernicious* ; Antibodies ; Gait ; Humans ; Intrinsic Factor ; Lower Extremity ; Middle Aged ; Paresthesia ; Proprioception ; Sensation ; Spinal Cord* ; Subacute Combined Degeneration* ; Vibration ; Vitamin B 12 Deficiency

No abstract available.
Magnetic Resonance Imaging* ; Spinal Cord* ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency

No abstract available.
Brain* ; Cerebral Infarction ; Hyperhomocysteinemia* ; Vitamin B 12 Deficiency* ; Vitamin B 12* ; Vitamins*

Folate and vitamin B12 are essential cofactors for homocysteine (Hcy) metabolism. Homocysteinemia has been related with cardiovascular and neurodegenerative disease. We examined the effect of folate and/or vitamin B12 deficiency on biomarkers of one carbon metabolism in blood, liver and brain, and analyzed the correlation between vitamin biomarkers in mild and moderate homocysteinemia. In this study, Sprague-Dawley male rats (5 groups, n = 10) were fed folate-sufficient diet (FS), folate-deficient diet (FD) with 0 or 3 g homocystine (FSH and FDH), and folate-/vitamin B12-deficient diet with 3 g homocystine (FDHCD) for 8 weeks. The FDH diet induced mild homocysteinemia (plasma Hcy 17.41 +/- 1.94 nmol/mL) and the FDHCD diet induced moderate homocysteinemia (plasma Hcy 44.13 +/- 2.65 nmol/mL), respectively. Although liver and brain folate levels were significantly lower compared with those values of rats fed FS or FSH (p < 0.001, p < 0.01 respectively), there were no significant differences in folate levels in liver and brain among the rats fed FD, FDH and FDHCD diet. However, rats fed FDHCD showed higher plasma folate levels (126.5 +/- 9.6 nmol/L) compared with rats fed FD and FDH (21.1 +/- 1.4 nmol/L, 22.0 +/- 2.2 nmol/L)(p < 0.001), which is the feature of "ethyl-folate trap"by vitamin B12 deficiency. Plasma Hcy was correlated with hepatic folate (r = -0.641, p < 0.01) but not with plasma folate or brain folate in this experimental condition. However, as we eliminated FDHCD group during correlation test, plasma Hcy was correlated with plasma folate (r = -0.581, p < 0.01), hepatic folate (r = -0.684, p < 0.01) and brain folate (r = -0.321, p < 0.05). Hepatic S-adenosylmethionine (SAM) level was lower in rats fed FD, FDH and FDHCD than in rats fed FS and FSH (p < 0.001, p < 0.001 respectively) and hepatic S-adenosylhomocysteine (SAH) level was significantly higher in those groups. The SAH level in brain was also significantly increased in rats fed FDHCD (p < 0.05). However, brain SAM level was not affected by folate and/or vitamin B12 deficiency. This result suggests that dietary folate- and vitamin B12-deficiency may inhibit methylation in brain by increasing SAH rather than decreasing SAM level, which may be closely associated with impaired cognitive function in nutritional homocysteinemia.
Animals ; Biomarkers ; Brain ; Carbon ; Diet ; DNA Methylation ; Folic Acid ; Homocysteine ; Homocystine ; Humans ; Hyperhomocysteinemia ; Liver ; Male ; Methylation ; Neurodegenerative Diseases ; Plasma ; Rats ; S-Adenosylhomocysteine ; S-Adenosylmethionine ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Vitamins

Vitamin B12 deficiency can cause neurologic complications in the spincal cord, brain, and optic and peripheral nerves. Subacute combined degeneration is a rare disease of demyelinating lesions of the spinal cord, affecting mainly the posterior and lateral columns of the thoracic cord. We report the MR imaging findings of a case of subacute combined degeneration of the spinal cord in a patient with vitamin B12 deficiency and mega-loblastic anemia.
Anemia ; Brain ; Humans ; Magnetic Resonance Imaging* ; Peripheral Nerves ; Rare Diseases ; Spinal Cord* ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency ; Vitamins

We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.
Delayed Diagnosis ; Gastritis, Atrophic* ; Homocysteine ; Humans ; Methylmalonic Acid ; Nervous System ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency ; Vitamin B 12* ; Vitamins*

Subacute combined degeneration (SCD) of the spinal cord is a neurological complication arising from vitamin B12 deficiency. Typical findings are demyelination and axonal loss of the posterior and lateral columns of the thoracic and cervical spinal cord, leading to sensory ataxia and paresthesia. Clinical and neurological features and MRI findings all contribute to the diagnosis of this entity. In the Korean medical literature, only one case of SCD involving pre-treatment MRI has been reported. We describe one case of SCD in a post-gastrecto-my patient who initially presented with progressive sensory abnormality in both upper and lower extremities and showed T2 hyperintensity in the posterior and lateral columns of the spinal cord; this diminished, with clinical improvement, after vitamin B12 therapy. Our report includes the MR images obtained during follow up.
Ataxia ; Axons ; Demyelinating Diseases ; Diagnosis ; Follow-Up Studies ; Humans ; Lower Extremity ; Magnetic Resonance Imaging* ; Paresthesia ; Spinal Cord* ; Subacute Combined Degeneration* ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Vitamins

BACKGROUND: Neutrophil hypersegmentation (NH) in peripheral blood is known to be usually associated with deficiency of vitamin B12 or folate. Iron deficiency anemia (IDA) is another suggested cause of NH based on a limited number of studies, but the mechanism is uncertain. There was no such study in Korea. METHODS: The study groups were 41 patients with IDA (four males, 37 females ; mean age, 43.63+/-15.71) and 39 hematologically normal patients (five males, 34 females ; mean age, 46.64+/-19.12). We counted the number of nuclear lobes for 100 neutrophils on Wright-stained peripheral blood smear. Two lobes were regarded as separate only if there was a clear filament or the isthmus between them contained no nuclear material. The neutrophils with uncertainty in nuclear lobe count were classified as 'folded'. RESULTS: NH was observed in 14.6% (6/41) of patients with IDA and 7.6% (3/39) of normal controls. Mean neutrophil lobe counts were 2.48+/-0.28 and 2.43+/-0.27, respectively. There was no statistical significance in these differences. CONCLUSION: We could not find significant relation between NH and IDA in Korean, which is different from studies performed in other countries. This result may suggest the possibility of racial differences in the mechanism connecting IDA and NH, if there is any.
Anemia, Iron-Deficiency* ; Female ; Folic Acid ; Humans ; Iron* ; Korea ; Male ; Neutrophils* ; Uncertainty ; Vitamin B 12