subacute combined degeneration of the spinal cord
Introduction
Introduction to subacute combined degeneration of the spinal cord Subacute combined degeneration of the spinal cord is a degenerative disease of the nervous system caused by vitamin B12 deficiency. Its clinical manifestations include deep sensory loss, sensory ataxia and spastic paralysis with spinal cord and lateral cord lesions, often accompanied by peripheral nerve damage. And the peripheral sensation of the symptoms. The disease is related to the deficiency of vitamin B12, which is a structure that promotes nerve impulse conduction around the nerve, and vitamin B12 is an essential coenzyme for the formation of myelin and nucleoprotein. The lack of vitamin B12 may cause myelin synthesis disorder and cause neurological and psychotic lesions; And because vitamin B12 is also involved in the synthesis of hemoglobin, lack of it can lead to anemia. basic knowledge The proportion of illness: 0.025% Susceptible people: more than middle-aged onset Mode of infection: non-infectious Complications: anemia, ataxia,
Cause
Subacute combined degeneration of spinal cord
Poor intake of vitamin B12 (45%):
The intake of vitamin B12 must be combined with the internal factors secreted by the cells in the stomach to form a stable complex, which will not be absorbed by the intestinal tract and absorbed in the distal ileum. Vitamin B12 intake, absorption, binding and transport occur at any point. obstacle.
Disease factors (40%):
Such as congenital defects of internal factor secretion, atrophic gastritis, major resection of the stomach, primary intestinal malabsorption, ileal resection, etc., will cause vitamin B12 deficiency, resulting in clinical symptoms.
The disease is related to the deficiency of vitamin B12, which is a structure that promotes nerve impulse conduction around the nerve, and vitamin B12 is an essential coenzyme for the formation of myelin and nucleoprotein. The lack of vitamin B12 may cause myelin synthesis disorder and cause neurological and psychotic lesions; And because vitamin B12 is also involved in the synthesis of hemoglobin, lack of it can lead to anemia.
Prevention
Subacute combined degeneration prevention of spinal cord
This disease mainly involves the posterior and lateral cord of the spinal cord. If the disease can be treated with vitamin B12 within 3 months after the onset of the disease, it can often be fully recovered. If it is not treated symptomatically, it often progresses after 2-3 years of onset. Even life-threatening, early diagnosis and timely treatment are the key to determining the prognosis of this disease.
Complication
Subacute combined degeneration complications of spinal cord Complications, anemia, ataxia
Usually accompanied by pernicious anemia, and due to its clinical manifestations, deep sensation loss, postural cord and lateral cord injury, sensory ataxia and spastic paralysis, often accompanied by peripheral sensory disturbance.
Symptom
Subacute combined degeneration symptoms of the spinal cord Common symptoms Walking on the cotton sensory hallucinations Depression sphincter dysfunction
1. More on middle-aged or older, there is no significant difference between men and women, chronic or sub-acute onset, slow progress, most patients have pale stagnation, diarrhea and glossitis before neurological symptoms, with serum VitB12 decreased, early symptoms are double The lower limbs are weak and hard, the hand movements are clumsy, the walking is unstable, the cotton feels, the gait and the base are widened; then the toes, the ends of the fingers continue to be symmetrical, numb and burning, etc., check the vibration of the lower limbs, position sense Obstruction, distal end is obvious, Romberg sign (+); a few have gloves, sock-like sensation, very few patients with spinal cord, lateral cord damage typical, but serum Vit.B12 content is normal (without subacute combined degeneration of VitB12 deficiency)
2. Incomplete paralysis of the lower extremities, increased muscle tone, hyperreflexia and pathological signs; if the peripheral neuropathy is heavier, the muscle tone is reduced, the tendon reflex is weakened, but the pathological signs are often positive. Lhermitte sign (acupuncture sensation from the lower extremity of the spine) occurs, and sphincter dysfunction can occur in the late stage.
3. Common psychiatric symptoms: irritability, depression, hallucinations, mental confusion and paranoid tendency, cognitive decline, and even dementia, a small number of patients with optic atrophy and central dark spots, suggesting that the white matter and optic nerve are widely involved, rarely affected Other cranial nerves
Examine
Examination of subacute combined degeneration of the spinal cord
1, cerebrospinal fluid is more normal, a small number may have a slight increase in protein.
2, injection of histamine for gastric juice analysis can be found to have anti-histamine acid deficiency.
3, peripheral blood and bone marrow smear examination showed giant cell hypochromic anemia; injection of vitamin B12100 micrograms / day, 10 days after reticulocyte increase is helpful for diagnosis.
4. The serum vitamin B12 content is reduced.
5, MRI scan (MRI) can show the posterior cord lesions.
Diagnosis
Diagnosis and differentiation of subacute combined degeneration of spinal cord
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
1. Spinal cord compression: Spinal cord compression, mainly spinal cord compression, such as cervical spondylosis with spinal stenosis, especially in patients with spinal canal dysfunction, spinal cord cerebrospinal fluid dynamics, protein content Elevation and spinal MRI visible lesions or disc herniation were identified.
2. Multiple sclerosis: especially chronic progressive multiple sclerosis, which can be manifested as deep sensory disturbance and progressive paralysis, with normal serum vitamin B12 concentration, fluctuations in the course of the disease, oligoclonal IgG zone positive in cerebrospinal fluid, etc. The characteristics can be identified. If it is difficult to identify, it can be used as a trial immunosuppressive therapy. Most patients with multiple sclerosis may have a good response, while the symptoms of subacute combined degeneration may be aggravated.
3. Spinal cord sputum: a manifestation of advanced neurosyphilis, manifested as spinal cord posterior cord and posterior root lesions, no pyramidal tract signs, patients complained of lightning-like nerve root pain, two lower extremity tendon reflexes disappeared, and may be accompanied by local Joint swelling, as well as a history of syphilis infection and serological tests were identified.
4. Peripheral neuropathy: vitamin deficiency can also be combined with peripheral neuropathy, so multivitamin deficiency and B12 deficiency can be combined with typical peripheral neuropathy in subacute combined degeneration, which is a vitamin deficiency disease, both coexisting, some sensorimotor Neuropathy presents a typical deep sensory disorder, but with a loss of peripheral sensation, sputum reflexes disappear or decrease, but serum vitamin B12 levels are normal and no erythrocyte anemia and dystrophies can be identified.
