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Subacute Combined Degeneration of Spinal Cord

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What is a differential for systemic diseases that can cause neurologic deficiencies at multiple levels?
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Terms in this set (27)
What is a differential for systemic diseases that can cause neurologic deficiencies at multiple levels?
HIV associated vacuolar myelopathy
Lyme disease
Multiple Sclerosis
Neurosyphilis
Vitamin B12
Define the spinal cord
tubular structure
originates from medulla and extends through bony spine to the coccyx
What do posterior columns control?
Joint position
Vibration and pressure
What do lateral spinothalamic columns control?
Pain
Temperature
What do ventral corticospinal tracts control?
Motor signals
Usual presentation of Vitamin B12 deficiency?
Parasthesias of hands and feet
Loss of vibratory sense
Diffusely affects the spinal cord-posterior lateral columns
Later: optic atrophy, mental changes, ataxia
What is B12 used in?
DNA synthesis
Methionine synthesis
Conversion of proprionyl into Succinyl coenzyme A from methylmalonate
What factors affect B12 absorption?
Stomach acid
R protein
Intrinsic Factor
Distal 80cm of ileum
Pernicious anemia
-Decreases absorption of B12
-Condition where antibodies are generated against parietal cells
SCD pathology
Edema and destruction of myelin
SCD initial symptoms
Paresthesia in hands and feet
SCD progressive symptoms
sensory loss
gait ataxia
distal weakness, especially in legs
Subacute Combined Degeneration
-syndrome of sensory loss
-spastic paresis associated with pathological lesions in dorsal columns and lateral corticosinal tracts
-macrocytic anemia
Differential Diagnosis for PROGRESSIVE SPASTIC PARAPLEGIA
-degenerative disorders
-demyelinating disorders
-infectious disorders
-inflammatory disorders
-neoplastic disorders
-nutritional disorders
-vascular disorders
-HIV, lyme, MS, neurosyphilis, toxic neuropathy, friedreich ataxia, vit E deficiency
Neurologic manifestations of Vit B12 deficiency
Paresthesia
Peripheral neuropathy
Combined systems disease (demyelination of dorsal columns and corticospinal tract)