Subacute combined degeneration

Alternative names:

SCD; subacute combined degeneration of the spinal cord

Symptoms:

• abnormal sensations of the legs, arms, trunk, or other area
  • tingling, "pins and needles", or "shock-like" sensations
  • numbness
  • progressively worsens
  • usually symmetrical

• weakness of the legs, arms, trunk, or other area
  • progressively worsens
  • usually symmetrical

• unsteady gait
• clumsiness, stiff, or awkward movements
• change in mental state
  • irritability
  • apathy
  • sleepiness
  • suspicious, paranoid
  • confused, disoriented, delirious
  • depression
  • dementia, intellectual deterioration

• vision changes
  • decreased vision

Speech impairment may also be associated with this disease.

Signs and tests:

An examination usually shows symmetrical sensorimotor polyneuropathy, with muscle weakness and sensation disturbance. Reflexes are often abnormal. Muscles may develop spasticity. There is a loss of position sense (awareness of body position) and sense of touch, pain, and temperature. Mental changes are variable, from mild forgetfulness to complete dementia or psychosis. Severe dementia is uncommon, but in some cases, it is the initial symptom of the disorder. An eye examination may indicate damage to the optic nerve (optic neuritis), with abnormal pupil responses, inflammation or atrophy of the optic nerve (visible on retinal exam), decreased visual acuity, and other changes.

• A CBC may show anemia if pernicious anemia is also present. If folic acid has been used to treat anemia, neurologic symptoms may develop even if the anemia is no longer evident.
• Serum B12 levels are low.