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Title: Subacute combined degeneration of the spinal cord despite prophylactic vitamin B12 treatment.
Austin Authors: Tsang, Benjamin K-T;Crump, Nicholas H ;Macdonell, Richard A L 
Affiliation: Department of Neurology, The Austin Hospital, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia
Issue Date: 18-Feb-2012
Publication information: Journal of Clinical Neuroscience 2012; 19(6): 908-10
Abstract: We describe a 35 year-old man presenting with a four-week history of non-painful limb paraesthesias and unsteady gait causing falls. On examination he had an ataxic gait associated with dorsal column sensory loss. He had a medical history of a partial gastrectomy six years prior and anaemia. He had received monthly intramuscular hydroxycobalamin injections since the gastrectomy. Laboratory tests revealed normal vitamin B12 and holotranscobalamin levels, a reduced serum caeruloplasmin of 0.05 g/L (normal: 0.22-0.58 g/L), a copper-to-caeruloplasmin ratio of 1.9 μmol/L (11.0-22.0 μmol/L) and a reduced 24-hour urinary copper concentration of <0.30 μmol/L (0-0.3 μmol/L). Cerebrospinal fluid analysis, nerve conduction studies, electromyography and visual-evoked responses were unremarkable. MRI revealed abnormal hyperintense signal in the cervical dorsal columns. Hypocupric myelopathy was diagnosed and he was treated with daily oral elemental copper. Three months later, his walking and balance had improved although there was no change noted on MRI.
DOI: 10.1016/j.jocn.2011.08.028
Type: Journal Article
Subjects: Adult
Gait therapy
Longitudinal Studies
Magnetic Resonance Imaging
Sensation therapy
Spinal Cord.pathology
Spinal Cord Diseases.complications.etiology.prevention & control
Subacute Combined Degeneration.complications.etiology.prevention & control
Vitamin B 12.administration & dosage
Appears in Collections:Journal articles

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