Subacute combined degeneration of the spinal cord due to vitamin B12 deficiency

Abstract

Introduction: subacute combined degeneration of the spinal cord is a myelopathy induced by vitamin B₁₂ deficiency. It produces symmetric dysesthesias, alterations of superficial and vibratory sensitivity. In advanced stages it causes defects of memory, learning, behavior, taste and smell.

Objective: to present the case of a patient diagnosed and treated by subacute combined degeneration of the spinal cord, a rare condition in Cuba.

Case presentation: female patient, 50 years old. She reported that two years before admission she presented progressive weakness in the lower limbs, adding coldness and numbness of the four limbs, wobbly march, palpitations, fatigue, headache, dyspnea and lemon yellow skin tint. She was given complementary laboratory, imaging and histological exams. The peripheral lamina showed marked anisocytosis and macrocytosis, presence of poikilocytes and polychromatofilia. The patient was given daily, in a single dose, 100 mg of vitamin B₁₂ for 10 days, with daily white blood cell count. She was discharged 15 days after, with instructions to continue the treatment. After three months she recovered 70 % of her cognitive and motor skills, with mobility of the four limbs.

Conclusions: the diagnosis of this disease requires a correct application of the clinical method, and the realization of laboratory, imaging and histological exams. This was possible due to the multidisciplinary care among specialists in internal medicine, hematology, imaging and gastroenterology. In this case, the age of the patient was not included in the range of presentation of the disease