View source for MYELOPATHY-SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD

===== [[Summary Article|'''SUMMARY''']] =====
1. B<sub>12</sub> deficiency causes segmental loss of myelin in the dorsal and lateral columns. 
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<br/>2. Clinical: gradual weakness associated with paresthesias and loss of proprioception with development of ataxia. 
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<br/>3. Severe cases end in extensive bilateral lower extremity weakness, spasticity, and urinary incontinence +/- cognitive impairment. 
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<br/>4. Cognitive changes include progressively worsening confusion, apathy, delusions, paranoia.
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<br/>5. Think of B<sub>12</sub> deficiency in a patient with brisk knee jerks (due to pyramidal tract dysfunction) and absent ankle jerks (due to peripheral neuropathy).
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<br/>6. Diagnose by measuring serum B<sub>12</sub>, methylmalonic acid (MMA), and homocysteine (HC) levels. In states of B12 deficiency, both MMA and HC are increased.


==Reference(s)==
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.]
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.]
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
<br/>Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].

[[Category:Myelopathy]]
[[Category:Neurology]]
[[Category:Medicine]]