Nov 19, 2019

Subacute combined degeneration of the spinal cord masking motor neuron disease: a case report

Journal of Medical Case Reports
Paula LovelandWen Kwang Lim

Abstract

Subacute combined degeneration of the spinal cord is a potentially reversible myelopathy typically associated with vitamin B12 deficiency. There is predominant involvement of spinal cord posterior and lateral tracts, and manifestations include peripheral paraesthesia, impaired proprioception, gait disturbance, neuropathy and cognitive changes. Motor neuron disease (MND) is an unremittingly progressive neurodegenerative disorder involving upper and lower motor neurons with an average prognosis of 2-3 years. The diagnosis is clinical and may be supported by electromyography. A subset of MND occurs concurrently with frontotemporal dementia (FTD-MND) and may be initially misdiagnosed as a primary psychotic disorder. We describe a 57-year-old Caucasian woman who presented with confusion and dysarthria. Low vitamin B12 levels and MRI findings led to an initial diagnosis of subacute combined degeneration of the spinal cord. Despite treatment, persistent dysarthria and presence of both upper and lower motor neuron signs on clinical examination prompted further assessment. Electromyography supported the diagnosis of MND. Comorbid chronic paranoid schizophrenia complicated the diagnostic process. We discuss overlapping features between B...Continue Reading

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Mentioned in this Paper

Magnetic Resonance Imaging
Upper
Nerve Degeneration
Vitamin B 12
Motor Neurons
Vitamin D Deficiency
Electromyography
Chronic Paranoid Schizophrenia
Mental Health
Evaluation

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