Clinical features of different stage subacute combined degeneration of the spinal cord

Abstract

Subacute combined degeneration (SCD), caused by vitamin B12 disorders, leads to severe degeneration of the spinal cord. Thus, it is significant to make timely diagnosis and treatment options of SCD. The objectives were to summarize clinical features of different sate SCD. Clinical data of 42 SCD patients of spinal cord were retrospectively analyzed, which were classified into early stage, middle stage and late stage SCD. Among the patients, 9 were classified into early stage, 22 into middle stage, and 11 into late stage SCD. Total cholesterol and hemoglobin levels were relatively higher in late stage SCD. In contrast, mean corpusular volume (MCV) level was higher in early stage SCD. There were typical abnormalities only in 8 patients on magnetic resonance imaging (MRI), and a dynamia was a common neurological abnormality in all patients. Importantly, the differences in abnormal findings in anti-nuclear antibodies (ANA) testing, visual acuity and fundus testing were statistically significant in different stage SCD ( P < .05). There were correlation between most variances with SCD stage. Strikingly, there existed close relationship between enhanced levels of blood glucose ( r = −0.289, P = .066), glycated hemoglobin (GHB) ( r = −0.288, P = .068) and homocysteine ( r = −0.563, P = .000), abnormal visual findings ( r = 0.309, P = .049) and megaloblastic anemia ( r = −0.295, P = .061) with different SCD stage, among which abnormal visual findings were closely associated with middle stage SCD. Moreover, levels of total cholesterol, blood glucose, homocysteine and abnormal finding of visual acuity were significant in diagnosis and clinical staging of SCD ( P < .05). Although MRI scanning and serum vitamin B12 level were widely used for SCD diagnosis, neurological examination and homocysteine level may be more potentially valuable indexes for SCD diagnosis and staging.

Coexistence of Guillain-Barré Syndrome and Subacute Combined Degeneration of the Spinal Cord Due to Autoimmune Gastritis: A Case Report and Literature Review

“…Although the presence of autoantibodies is important for diagnosing AIG, their absence does not completely exclude the disease. The titer of anti-parietal cell antibodies may gradually decrease during the different stages of development of the disease, and patients with advanced disease may even show negative anti-parietal cell antibodies due to the absence of parietal cells [ 18 ]. Furthermore, studies indicate that the absence of anti-parietal cell antibodies is more common in elderly patients with AIG [ 19 ].…”

Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus

“…Several topics showed consistent results between the studies (Table S6). Macrocytic anemia is not related to the presence or absence of neurological symptoms or their severity [15][16][17][18]. The serum concentration of vitamin B12 is commonly used as a primary marker of vitamin B12 status.…”

Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus

“…Several topics showed consistent results between the studies (Table S6). Macrocytic anemia is not related to the presence or absence of neurological symptoms or their severity [11,[18][19][20][21]. The serum concentration of vitamin B12 is commonly used as a primary marker of vitamin B12 status.…”