TY  - CHAP
M1  - Book, Section
TI  - Subacute Combined Degeneration of the Spinal Cord
A1  - Douglas, Vanja C.
A1  - Aminoff, Michael J.
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
A2  - McQuaid, Kenneth R.
Y1  - 2023
N1  - 
T2  - Current Medical Diagnosis & Treatment 2023
AB  - Subacute  combined  degeneration  of  the  spinal  cord  is  due  to  vitamin  B12  deficiency,  such  as  occurs  in  pernicious  anemia.  It  is  characterized  by  myelopathy  with  spasticity,  weakness,  proprioceptive  loss,  and  numbness  due  to  degeneration  of  the  corticospinal  tracts  and  posterior  columns.  Polyneuropathy,  mental  changes,  or  optic  neuropathy  also  develop  in  some  patients.  Megaloblastic  anemia  may  also  occur,  but  this  does  not  parallel  the  neurologic  disorder,  and  the  former  may  be  obscured  if  folic  acid  supplements  have  been  taken.  Treatment  is  with  vitamin  B12.  For  pernicious  anemia,  a  convenient  therapeutic  regimen  is  1000  mcg  cyanocobalamin  intramuscularly  daily  for  1  week,  then  weekly  for  1  month,  and  then  monthly  for  the  remainder  of  the  patient’s  life.  Oral  cyanocobalamin  replacement  is  not  advised  for  pernicious  anemia  when  neurologic  symptoms  are  present.  A  similar  syndrome  is  caused  by  recreational  abuse  of  inhaled  nitrous  oxide  due  to  its  interference  with  vitamin  B12  metabolism.  Copper  deficiency,  caused  by  malabsorption  or  excess  zinc  ingestion,  may  also  be  responsible.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1193129305
ER  -