Subacute Combined Degeneration of the Spinal Cord



In this serious disease of the spinal cord, the so-called white matter gradually degenerates and produces symptoms due to this fact. It is caused by a deficiency of vitamin B12 (Cyanocobalamin), and is frequently associated with Pernicious Anemia. It is now seen much less often, probably due to the widespread use of the vitamin B complex in today’s modern society.

Vitamin B12 is essential for the normal production of the blood, and its deficiency also leads to a fatal form of anemia if left untreated. However, as symptoms invariably lead to prompt diagnosis (on a blood count and examination of a “blood film” by the pathologist) treatment is always commenced early, so that advanced cases of the disease are now rarely encountered.



Subacute Combined Degeneration of the Spinal Cord Symptoms

These usually commence gradually, with numbness and tingling in the feet being a common set of initial symptoms. To a lesser extent this sensation may lingers. Sometimes the patient may complain of coldness or swelling in the feet, or feeling similar to stepping on cotton wool. Usually the sensory loss gradually extends to cover the “sock” area, and later on to the “stocking” area. Gradually the patient becomes insensitive to temperature and pain, and the sense of position. Unsteadiness in walking follows.

As the condition progresses, there is wasting of the muscles, usually those below the knee being affected first. These paralyzed muscles may become very painful and tender, and movement may be difficult and cause pain. Sometimes there is visual impairment, and mental changes may take place. Apathy, memory loss and confusion are common. Often routine blood tests will detect the anemia.



Subacute Combined Degeneration of the Spinal Cord Treatment

Treatment is usually successful and often spectacular, particularly in early cases, by the injection of vitamin B12 regularly. It is less successful in advanced cases, but any patient with this disorder should be treated vigorously with vitamin B12 therapy.

POST VIRAL SYNDROME Dealt with more fully under Upper Respiratory Tract Infections, post viral syndrome deserves mention here. It has been around for centuries, being well-known in the 1800s and early 1900s as “neurasthenia”. Feeling tired and incapable of performing a normal day’s work are the key symptoms. A check indicates this is followed by a simple bout of the flu. It may take days or weeks to become noticeable. Often swollen glands in the neck, armpits, groin and elsewhere occur. Before diagnosed, all other possible causes must be excluded by tests. It is a diagnosis of elimination and history. Fortunately, many patients gradually improve over a period of months or even years.



Occasionally it may persist and worsen, causing partial paralysis, a condition known as ME (Myalgic Encephalomyalgia). This is rare, with the patient in severe cases being confined to a wheelchair. Much research attention by major universities and teaching hospitals around the world is focused on the disease, its cause and treatment. Australia is in the forefront of research. At present, encouragement, adequate rest, exercise within a person’s tolerance, sensible nutrition, probably vitamins are the mainstay of treatment. There is no specific drug or routine that is curative. Several self help organizations provide information, counseling and support for the various nerve-related disorders. Persons wishing to contact any of these self help organizations should check their local telephone directory for locations