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Sequential involvement of the nervous system in subacute combined degeneration

 Yang-Ki Minn  ;  Seung-Min Kim  ;  Se-Hoon Kim  ;  Ki-Han Kwon  ;  Il-Nam Sunwoo 
 YONSEI MEDICAL JOURNAL, Vol.53(2) : 276-278, 2012 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Evoked Potentials, Somatosensory/physiology ; Female ; Humans ; Male ; Middle Aged ; Subacute Combined Degeneration/blood* ; Subacute Combined Degeneration/metabolism ; Subacute Combined Degeneration/physiopathology* ; Vitamin B 12/blood ; Vitamin B 12 Deficiency/blood ; Vitamin B 12 Deficiency/complications ; Young Adult
Vitamin B12 ; subacute combined degeneration ; spinal cord ; somatosensory evoked potential ; nisual evoked potential
PURPOSE: Subacute combined degeneration (SCD) involves progressive degeneration of the spinal cord, optic nerve, and peripheral nerves. Vitamin B12 (VB12) is a co-factor in myelin synthesis. Because each cell that constitutes the myelin component in the central nervous system and peripheral nervous system is different, it is improbable that these cells undergo simultaneous degeneration. However, the sequence of degeneration in SCD has not been established. MATERIALS AND METHODS: In this study, we analysed medical records and electrophysiological data of patients who showed neurological symptoms and whose serum VB12 levels were lower than 200 pg/mL. RESULTS: We enrolled 49 patients in this study. Their mean VB12 level was 68.3 pg/mL. Somatosensory evoked potential (SEP) study showed abnormal findings in 38 patients. Of the 40 patients who underwent visual evoked potential (VEP) study, 14 showed abnormal responses. Eighteen patients showed abnormal findings on a nerve conduction study (NCS). In this study, abnormal posterior tibial nerve SEPs only were seen in 16 patients, median nerve SEPs only were seen in 3 patients, abnormal VEPs only in two, and abnormal NCS responses in one patient. No patient complained of cognitive symptoms. CONCLUSION: In SCD, degeneration appears to progress in the following order: lower spinal cord, cervical spinal cord, peripheral nerve/optic nerve, and finally, the brain.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Seung Min(김승민) ORCID logo https://orcid.org/0000-0002-4384-9640
Sunwoo, Il Nam(선우일남)
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