Guntupalli Lohitha, Lurie Andrew, Stoll Veenah, Lugo Luis Daniel
Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Cureus. 2023 Jul 28;15(7):e42593. doi: 10.7759/cureus.42593. eCollection 2023 Jul.
Folate deficiency is a rare cause of subacute combined degeneration (SCD). SCD is characterized by demyelination of the dorsal and lateral columns of the cervical and thoracic spine most commonly caused by vitamin B12 deficiency. Folate deficiency, which can be clinically indistinguishable from B12 deficiency, leads to a variety of presentations, including absent vibratory sensation and proprioception, sensory ataxia, and progressive motor weakness. Recognizing the clinical sequelae of SCD is essential for timely diagnosis and treatment. We present a case of a 38-year-old male with progressive ascending bilateral lower extremity numbness and motor weakness in the presence of normal vitamin B12 and methylmalonic acid levels. MRI of the entire neuraxis revealed a diagnosis of SCD, which was managed with oral folate replacement. We aim to highlight this rare cause of SCD, which can lead to permanent neurological deficits if not promptly recognized and treated.
叶酸缺乏是亚急性联合变性（SCD）的罕见病因。SCD的特征是颈段和胸段脊柱的背侧和外侧柱脱髓鞘，最常见的原因是维生素B12缺乏。叶酸缺乏在临床上与维生素B12缺乏难以区分，可导致多种表现，包括振动觉和本体感觉缺失、感觉性共济失调以及进行性运动无力。认识SCD的临床后遗症对于及时诊断和治疗至关重要。我们报告一例38岁男性病例，该患者在维生素B12和甲基丙二酸水平正常的情况下，出现进行性双侧下肢麻木和运动无力。全神经轴MRI显示诊断为SCD，采用口服叶酸替代治疗。我们旨在强调这种SCD的罕见病因，如果不及时识别和治疗，可能导致永久性神经功能缺损。
