Subacture combined degeneration of cord is caused due to deficiency of
Correct Answer: Vitamin B12
Description: Ans. is 'd' i.e., Vitamin B12 Subacate combined degeneration of the spinal cord is the term used for the degeneration of the spinal cord due to vitamin B12 deficiency. The spinal cord, brain, optic nerves, peripheral nerves may all be affected in vitamin B12 deficiency but the spinal cord is usually affected first and exclusively. The tracts mainly involved in the spinal cord are: o Posterior column Coicospinal tract Later on peripheral nerves are involved Clinical features of vitamin B deficiency or subacute combined degeneration of the cord : Patient first notices mild general weakenss and paresthesia consisting of tingling 'pins and needle'. As the illness progresses the gait becomes unsteady and stiffness and weakenss of the limbs and legs develop. If the disease remains untreated ataxic paraplegia evolve. Sometimes there may be loss of superficial sensations, such as tactile, pain and thermal sensations, but these signs are rare. Loss of "vibration sense" is the most consistent sign and is usually accompanied by loss of position sensee. Motor signs seen are:- Loss of strength in proximal limb muscles Spasticity, changes in tendon reflexes Clonus and extensor plantar responses Sometimes tendon reflexes may be absente (due to involvement of peripheral nerve) o Gait is ataxic Now, The Clinicopathological Correlation Clinical features Tracts involved Paresthesia, inpairment of deep sensation and ataxia Due to lesion in posterior column Weakness, spasticity and increased tendon reflexes Due to coicospinal tract involvement Occasional findings of loss of pain and temperature Due to spinothalamic tract involvement (rarely involved) Distal and symmetrical impairmeat of superficial Involvement of peripheral nerve (occassionally)
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