Subacute combined degeneration of spinal cord, also known as Lichtheim

Ludwig Lichtheim

Ludwig Lichtheim was a German physician. He was educated at the gymnasium in Breslau, and studied medicine at the universities of Berlin, Zurich, and Breslau, graduating in 1868...

's disease, refers to degeneration of the posterior and lateral columns of the spinal cord

Spinal cord

The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

 as a result of vitamin B₁₂ deficiency

Vitamin B12 deficiency

Vitamin B12 deficiency or hypocobalaminemia is a low blood level of vitamin B12, it can cause permanent damage to nervous tissue as a long term effect. Vitamin B12 was discovered from its relationship to the disease pernicious anemia, which is an autoimmune disease that destroys parietal cells in...

 (most common), vitamin E deficiency

Vitamin E deficiency

-Presentation:Signs of vitamin E deficiency include neuromuscular problems such as spinocerebellar ataxia and myopathies. Other neurological signs may include dysarthria, absence of deep tendon reflexes, loss of vibratory sensation and proprioception, and positive Babinski sign.Deficiency can also...

 or Friedrich's ataxia. It is usually associated with pernicious anemia

Pernicious anemia

Pernicious anemia is one of many types of the larger family of megaloblastic anemias...

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Presentation

The pathological findings of subacute combined degeneration consist of patchy losses of myelin

Myelin

Myelin is a dielectric material that forms a layer, the myelin sheath, usually around only the axon of a neuron. It is essential for the proper functioning of the nervous system. Myelin is an outgrowth of a type of glial cell. The production of the myelin sheath is called myelination...

 in the dorsal and lateral columns. Patients present with weakness of legs, arms, trunk, tingling and numbness that progressively worsens. Vision changes and change of mental state may also be present. Bilateral spastic paresis

Paresis

Paresis is a condition typified by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach , and also the vocal cords...

 may develop and pressure, vibration and touch sense are diminished. A positive Babinski sign may be seen. Prolonged deficiency of vitamin B₁₂

Vitamin B12

Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...

 leads to irreversible nervous system damage.

If someone is deficient in vitamin B₁₂ and folic acid, the vitamin B₁₂ deficiency must be treated first to avoid precipitating subacute combined degeneration of the cord.

Treatment

Therapy with vitamin B₁₂ results in partial to full recovery, depending on the duration and extent of neurodegeneration

Neurodegeneration

Neurodegeneration is the umbrella term for the progressive loss of structure or function of neurons, including death of neurons. Many neurodegenerative diseases including Parkinson’s, Alzheimer’s, and Huntington’s occur as a result of neurodegenerative processes. As research progresses, many...

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External links

• http://www.neuropathologyweb.org/chapter8/chapter8Nutritional.html
• http://www.macrorad.com/case-reports/subacute-combined-degeneration.html