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

Background: Several studies reported a high prevalence of vitamin B12 deficiency in some Asian countries and in Asian immigrants living in Western countries. However, there is no data regarding the prevalence of vitamin B12 deficiency in Viet Nam.\r\n', u'Objectives: The aim of this study was to determine the prevalence of vitamin B12 deficiency in patients with upper gastrointestinal symptoms in the Mekong Delta and to investigate the risk factors for vitamin B12 deficiency. \r\n', u'Methods: Blood samples were collected from patients visiting Can Tho General Hospital for upper gastrointestinal endoscopy. Serum vitamin B12 concentration was measured at the University Medical center St Radboud Nijmegen, Netherlands. \r\n', u'Results: Between September and December 2003, 216 patients (80 male, 136 female, mean age 43.2 years) were studied. Ten patients had gastric cancer, 28 peptic ulcer disease/ and 178 gastritis only or no visible pathology. Only 2 patients (0.9%) had clinical vitamin B12 deficiency (<160 pmol/l, whereas 15 patients (7.0%) had sub-clinical vitamin 812 deficiency (160-250 pmol/l). H. pylori positive patients (n=111) were more likely to have para-clinical vitamin B12 deficiency than H. pylori negative patients (odds ratio 3.7~ 95%CI 1.10-12.76). \r\n', u'Conclusions: Vitamin B12 deficiency is uncommon in the Mekong Delta. Helicobacter pylori infection is a risk factor for vitamin B12 deficiency. \r\n', u'
Vitamin B12 deficiency ; gastroenterologic symptoms

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

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

BACKGROUND: The traditional treatment of cobalamin deficiency anemia is performed by intramuscular injections. However, it has been suggested that oral replacement of cobalamin is also effective as an intramuscular injection. We studied the effectiveness of oral mecobalamin treatment in patients with cobalamin deficiency. METHODS: Patients with newly diagnosed cobalamin deficiency (<200 pg/mL) or who were previously maintained on intramuscular injection were given 2,000 microgram of oral mecobalamin daily. RESULTS: Sixteen patients were enrolled. The common causes of cobalamin deficiency were total gastrectomy (75%) and pernicious anemia (12.5%). Twelve patients received oral mecobalamin, except for four patients who were lost from follow-up after initial diagnosis. The mean pretreatment values of serum cobalamin and hemoglobin level were 58.3+/-21.9pg/mL and 8.1+/-1.9g/dL, respectively. After one, two, and six months of oral therapy, the respective mean values were 1,691.8+/-260.4pg/mL, 1,085.8+/-1,110.3pg/mL and 990.2+/-249.8pg/mL of serum cobalamin, and 10.4+/-1.3g/dL, 11.3+/-2.2g/dL and 12.1+/-2.3g/dL of hemoglobin. Initially elevated serum homocysteine were normalized after one month of oral therapy. Symptoms such as glossitis were relieved rapidly by oral treatment. CONCLUSION: High-dose oral mecobalamin supplement was a simple and effective treatment in patients with cobalamin deficiency, especially in total gastrectomized patients.
Anemia ; Anemia, Pernicious ; Diagnosis ; Follow-Up Studies ; Gastrectomy ; Glossitis ; Homocysteine ; Humans ; Injections, Intramuscular ; Vitamin B 12 Deficiency ; Vitamin B 12*

BACKGROUND: Pernicious anemia is the most common cause of vitamin B12 deficiency in western populations, but to date, only case reports or small series dealing with this malady have been reported in Korea. This study describes the clinical characteristics of pernicious anemia in Koreans. METHODS: We retrospectively analyzed the clinical data for twenty-two Korean patients with pernicious anemia who were diagnosed during the period from 1995 to 2004 at Chungnam National University Hospital. RESULTS: Only two patients were diagnosed before 2000. The median age of the patients was 66 years and the male/female ratio was 1.8. Anemia-associated discomfort was the most common symptom (95.5%); this was followed by gastrointestinal and neurological symptoms (77.2% and 50.0%, respectively). Autoimmune disorders were found in five patients (22.7%). The median hemoglobin level was 7.0g/dL (range: 3.1~11.8g/dL) and pancytopenia was found in 12 patients (54.5%). The median serum vitamin B12 Level was 26pg/mL (range: 12~189pg/mL). Fifteen (78.9%) and eight (42.1%) of the 19 patients who underwent tests for antibodies were positive for anti-intrinsic factor and anti-parietal cell antibody, respectively. Nineteen of 21 patients who were treated with intramuscular cobalamin recovered from their cytopenia within 3 months. The gastrointestinal symptoms resolved completely for all the patients, while neurological symptoms remained for some of the patients. CONCLUSION: This study shows that the clinical features of pernicious anemia in Koreans are not different from those of the western cases. In addition, pernicious anemia is not a rare finding in Korea.
Anemia, Pernicious* ; Antibodies ; Chungcheongnam-do ; Humans ; Korea ; Pancytopenia ; Retrospective Studies* ; Vitamin B 12 ; Vitamin B 12 Deficiency

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

Iron deficiency anemia (IDA) and megaloblastic anemia due to vitamin B12 deficiency are well-characterized prototypes of anemia. There is no doubt that IDA is the most common hematologic disorder in Korea and worldwide as well. The diagnosis and treatment of IDA is not a difficult practice usually, however, a caution is required in detecting early-stage iron deficiency and in distinguishing IDA from anemia of chronic disorders such as chronic inflammatory disease, malignancies, chronic liver disease, and chronic renal disease. Administration of a standard iron preparation at a proper dosage over an adequate period is a prerequisite for the successful treatment of IDA, which is sometimes overlooked by both physicians and patients. Early detection and treatment as well as prevention of iron deficiency per se are also required. Pernicious anemia is the most common cause of vitamin B12 deficiency in Western populations. By contrast, the disorder is rare in Korea, although the number of cases seems to be increasing these days. The majority of patients with megaloblastic anemia reveal a history of gastrectomy. Thus, it should be reminded that vitamin B12 supplementation is important to prevent the development of overt deficiency or anemia in these susceptible individuals, since a delay in the treatment of vitamin B12 deficiency may result in an irreversible neurologic deficit.
Anemia* ; Anemia, Iron-Deficiency ; Anemia, Megaloblastic ; Anemia, Pernicious ; Diagnosis ; Gastrectomy ; Humans ; Iron ; Korea ; Liver Diseases ; Neurologic Manifestations ; Renal Insufficiency, Chronic ; Vitamin B 12 ; Vitamin B 12 Deficiency