Combined spinal degeneration: a classic presentation that should not be overlooked

Abstract

 Subacute combined degeneration (SCD) of the spinal cord is a rare neurological condition associated with cobalamin deficiency. We report the case of a 48-year-old man presented with sensory ataxia, pyramidal signs, and ineffective erythropoiesis secondary to hypovitaminosis B12. Spinal MRI revealed extensive hyperintensity in the posterior and lateral funiculi. Anti-parietal cell antibodies were positive, and upper endoscopy showed severe atrophic pangastritis, consistent with autoimmune atrophic gastritis. The investigation of hypoproliferative anemia, combined with dorsolateral spinal cord syndrome, allows for the consideration of SCD and should include the measurement of not only vitamin B12 but also more sensitive biomarkers, such as: homocysteine and methylmalonic acid. SCD should be included in the differential diagnosis of subacute spinal cord syndromes, as it is a potentially reversible condition with high morbidity.