Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India.
Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
BMJ Case Rep. 2021 Jan 25;14(1):e239415. doi: 10.1136/bcr-2020-239415.
A 42-year-old man from rural India presented with asymmetric progressive paraparesis mimicking compressive dorsal myelopathy, followed by distal upper limb, truncal and neck-flexor weakness, further complicated by acute urinary retention. His sensory deficits were marked by loss of joint position sense (JPS) and graded loss of vibration sense, along with a definite sensory level. Deep tendon jerks were hypo-to-areflexic, plantar was bilaterally extensor. He had become less attentive and occasionally failed to keep track with conversations. A syndromic diagnosis of myeloradiculoneuropathy with cognitive impairments was made. Further tailored investigations revealed vitamin B deficiency with positive anti-parietal cell antibody. Diagnosis of subacute combined cord degeneration (SACD) was confirmed. Neuro-imaging revealed intramedullary intensity changes only along lateral aspect of spinal cord instead of characteristic posterior involvement. Following parenteral vitamin B supplementation, patient started showing improvement in motor power and subjective sensory symptoms. His bladder symptoms persisted initially, however recovered finally after 6 months.
一位来自印度农村的 42 岁男性，表现为不对称性进行性截瘫，类似于压迫性背侧脊髓病，随后出现远端上肢、躯干和颈部屈肌无力，并伴有急性尿潴留。他的感觉缺陷表现为关节位置觉（JPS）丧失和振动觉分级丧失，以及明确的感觉水平。深腱反射低至无反射，跖反射双侧为伸展性。他变得注意力不集中，偶尔无法跟上对话。做出了神经根神经病伴有认知障碍的综合征诊断。进一步的针对性调查显示维生素 B 缺乏和壁细胞抗体阳性。确诊为亚急性联合脊髓变性（SACD）。神经影像学显示脊髓内仅沿脊髓侧面出现强度变化，而不是特征性的后部受累。静脉注射维生素 B 补充后，患者的运动力量和主观感觉症状开始改善。他的膀胱症状最初持续存在，但在 6 个月后最终恢复。
