Clinical Analysis Of Subacute Combined Degeneration Of The Spinal Cord.

Background:Subacute combined degeneration of the spinal cord (SCD)is caused by the deficiency of vitamin B12 ,and the foci of the disease are reversible by the treatment of vitamin B12. The degree of residual disability mainly correlates with the duration of symptoms and the severity of neurological disorders prior to treatment.Objective: To investigate and analyze the clinical characteristics of subacute combined degeneration of the spinal cord.Methods: The clinical data of 85 cases of subacute combined degeneration of the spinal cord were retrospectively analyzed. Results: All patients were from 31 to 82 years old with the mean age of 57.69, and the ration of males and females was 1.13:1. Before their hospitalization, 15.29% (13/85) patients were alcoholic, 40.00% (34/85) had chronic gastroenteric diseses or gastrectomy, 16.47% (14/85) were long-term vegetarians, 5.88% (5/85) had anemia. All patients had typical clinical manifestations. The original symptoms were paraesthesiae of limbs ,which accounted for 31.76%(27/85), dyskinesia of limbs accounting for 28.23%(24/85), limb paraesthesiae accompanied with limb dyskinesia accounting for 31.76%(27/85), and others for 8.24%(7/85). 63.53% (54/85) , 35.29%(30/85) and 75.29%(64/85) patients had lower myodynamia,changed muscular tone and tendon reflex respectively. Sensory disturbance including algesia/hypalgesia and loss of vibratory sensation/proprioception accounted for 78.82%(67/85),89.41%(76/85) respectively ,then 77.64%(66/85) patients had positive Romberg's sign on physical examination. The laboratory studies showed that 45.24%(38/85) and 53.33%(24/45) patients had low level of haemoglobin and serum vitamin B12, while 7 cases had low level of serum folate with normal or high level of serum vitamin B12.77.78%(21/27) patients showed abnormal electromyography. After vitamin B12 treatment, 82.35% (70/85) patients had some degree of improvements.Conclusions:1.Subacute combined degeneration of the spinal cord is a chronic progressive disease, commonly appearing to people over middle-age, and males are more common than females, most of whom have risk factors of vitamin B12 deficiency. 2.Measuring of serum homocysteine and methylmalonic acid are necessary for patients without anemia, especially elderly patients, that are suspected to SCD highly ,but having high or normal serum vitamin B12 concentrations, to define if they have real vitamin B12 deficiency. 3. Folate deficiency may cause SCD independently.