Abstract
Sub-acute combined degeneration is a neuropsychiatrical pathology associated with vitamin B12 deficiency It is clinically manifested through sensorial ataxia, peripheral neuropathy, cognitive dysfunction and optical neuropathy; these manifestations are generally attributed to the abnormal synthesis of myelin. It can have a nonspecific clinical presentation but the measurement of the levels of vitamin B12, some serum metabolites, and the use of neuroimaging methods help to confirm the diagnose when suspected. The case of a patient with sub-acute combined degeneration is described below. The patient was attended because of neurological symptoms and severe hypertension, and after the treatment, the patient's neurological and vascular symptomatology improved.
References
Pérez GP, Paredes JO, Ruiz ML. Degeneración combinada subaguda de la médula espinal por deficiencia de vitamina B12. Revista Médica del Hospital General de México. 2002;65(2):88-92.
Briani C, Torre CD, Citton V, Manara R, Pompanin S, Binotto G, Adami F. Cobalamin Deficiency: Clinical Picture and Radiological Findings. Nutrients. 2013;5(11):4521-4539. doi:10.3390/nu5114521.
Stabler SP. Vitamin B 12 Deficiency. New Engl J Med. 2013;368:149-60. doi:10.1056/NEJMcp1113996.
Sathe Y, Daga S. MRI Diagnosis Of Subacute Combined Degeneration Of Spinal Cord. Internet J Pediatr Neonatol. 2007;9(1):2-4.
Mechán V, Ramirez J, Wong G, Ballena I, Quispe L. Encefalopatía y degeneración subaguda combinada por deficiencia de vitamina B 12. Revista de la Sociedad Peruana de Medicina Interna. 2012;25(3):135-40.
Mudiyanselage D, Jayawickreme KP, Ekanayake EM, Jayalath WA. B 12 deficiency with neurological manifestations in the absence of anaemia. BMC Res Notes. 2015;(8):458. doi:10.1186/s13104-015-1437-9.
Franco RG, Ballesteros LB, Santacruz JG, San U. Degeneración combinada subaguda, neuropatía periférica y neuropatía óptica en un paciente con anemia perniciosa. Reporte de un caso en el Hospital Universitario San Ignacio. Universitas Médica. 2004;45:133-5.
Botero Echeverry, JC, Maya Gallego, C. Degeneración subaguda combinada de cordón espinal posterior secundario a deficit de vitamina B12. Reporte decaso. CES Medicina. 2007;21(2):103-9. http://www.redalyc.org/articulo.oa?id=261121001011
Bastidas TOZ, Betancourt CE, et al. Degeneración combinada subaguda, anemia megaloblastica y manifestaciones neuropsiquiatricas, caracterización clínica de catorce casos con deficiencia de cianocobalamina. Revista Medicina. 2012;34(2):104.
Makdsi F, Kadrie T. Sub-acute combined degeneration with an initially normal level of vitamin B12: a case report. Cases J. 2009;2:6944. doi:10.4076/1757-1626-2-6944.
Barrios MF, Gautier H. Vitamina B12: Metabolismo y Aspectos Clínicos de su Deficiencia. Revista Cubana de Hematología, Inmunología y Hemoterapia. 1999;15(3):159-74.
Hag T, Haratz S, Zavala J, Munhoz RP, Scola RH, Werneck LC. Case report Lhermitte's sign and vitamin B12 deficiency : case report. Sao Paulo Med J. 2009;127(3):171-3.
Lee W, Hsu H, Wang P. Reversible Myelopathy on Magnetic Resonance Imaging Due to Cobalamin Deficiency. J Chin Med Assoc. 2008;71(7):368-72.
Montes MI. Acute authonomic peripheral neuropathy. Acta Neurológica Colombiana. 2010;26(3):10-4.
Palazón Cabanes B, Martínez Lerma EJ, Fuentes Fernández I, Hernández Clares R. Presentación tardía de una encefalopatía de Wernicke tras gastrectomía por adenocarcinoma gástrico: a propósito de un caso. Acta Neurológica Colombiana. 2015;31(4):412-6.
Espinosa H. Resonancia magnética funcional. Acta Neurológica Colombiana. 2004; Capitulo 1(Figura 1):185-195.
Verma R, Kori P, Patil TB, Praharaj HN. Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B 12 de fi ciency. BMJ Case Rep. 2013:1-3. doi:10.1136/bcr-2013-009090.
Rannel HL, Watterson R, Pandya R, Leung AA. Vitamin B 12 deficiency "with combined hematological and neuropsychiatric derangements : a case report. J Med Case Rep. 2014;8(1):277. doi:10.1186/1752-1947-8-277.
Patil VM, Bhagwat KA, Gill HS, Khanapur R, Box P, Patil VM. Sub-acute combined degeneration of the spinal cord - Inverted " V" sign a clue to avoid morbidity. Asian Journal of Biomedical Pharmaceutical Science. 2014;4(39):42-45. doi:10.15272/ajbps.v4i39.626.
Devalia V, Hamilton MS, Molloy AM, British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513. doi:10.1111/bjh.12959.
Barriga JD. Common diseases in small fiber neuropathies Revisión. Acta Neurol (Napoli). 2011;27(3).
Dogan M, Ariyuca S, Peker E, Akbayram S, Dogan §Z, Ozdemir O, Cesur Y Psychotic disorder, hypertension and seizures associated with vitamin B12 deficiency : a case report. Hum Exp Toxicol. 2012;31(4):410-3. doi:10.1177/0960327111422404.
Reinoso Pérez FL, Rivas Pollmar I, Paz Arias R de, Hernández Navarro F. Diagnóstico y tratamiento de las anemias megalo-blásticas. Medicine (Baltimore). 2008;10(20):1326-33.
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