Kostick Nathan, Chen Evan, Eckert Tabitha, Sirotkin Igor, Baldinger Esther, Frontera Alfred
University of Central Florida College of Medicine, Orlando.
Department of Radiology, Bay Pines Veterans Affairs Healthcare System, Florida.
Fed Pract. 2022 Mar;39(3):142-146. doi: 10.12788/fp.0228. Epub 2022 Mar 14.
Subacute combined degeneration (SCD) is a rare complication of chronic vitamin B12 deficiency that presents with a variety of neurologic findings, including decreased sensation in the extremities, increased falls, and visual changes. Treatment of SCD involves prompt replacement of vitamin B12 and addressing the underlying conditions that cause the deficiency. Given the prevalence of B12 deficiency in the older adult population, clinicians should remain alert to its possibility in patients who present with progressive neuropathy.
This report presents a case of a patient with progressive SCD secondary to chronic B12 deficiency despite monthly intramuscular B12 injections.
Appropriate B12 replacement is aggressive and involves intramuscular B12 1000 mcg every other day for 2 to 3 weeks, followed by additional IM administration every 2 months before transitioning to oral therapy. Failure to adequately replenish B12 can lead to progression or lack of resolution of SCD symptoms.
亚急性联合变性（SCD）是慢性维生素B12缺乏的一种罕见并发症，表现为多种神经系统症状，包括肢体感觉减退、跌倒增加和视觉改变。SCD的治疗包括迅速补充维生素B12以及处理导致缺乏的潜在病因。鉴于老年人群中维生素B12缺乏的患病率，临床医生应对出现进行性神经病变的患者警惕其可能性。
本报告介绍了一例尽管每月进行一次肌肉注射维生素B12，但仍因慢性维生素B12缺乏继发进行性SCD的患者。
适当的维生素B12补充是积极的，包括每两天肌肉注射1000微克维生素B12，持续2至3周，随后在过渡到口服治疗前每2个月额外进行一次肌肉注射。未能充分补充维生素B12可导致SCD症状进展或无法缓解。
