Subacute combined degeneration (SCD) is a disorder the the spine, brain, and also nerves. It involves weakness, abnormal sensations, mental problems, and also vision difficulties.

You are watching: Combined spinal cord degeneration due to pernicious anemia


SCD is led to by vitamin B12 deficiency. It greatly affects the spinal cord. But its effects on the brain and the peripheral (body) nerves are the reason for the hatchet "combined." at first, the nerve extending (myelin sheath) is damaged. Later, the whole nerve cell is affected.

Doctors execute not know precisely how a lack of vitamin B12 loss the nerves. That is possible that the absence of this vitamin causes abnormal fatty acids to type around cells and also nerves.

People room at high risk for this condition if vitamin B12 can not be took in from your intestine or if they have:

Problems absorbing nutrients, which can happen after gastrointestinal surgery

Symptoms include:

Abnormal sensations (tingling and also numbness)Weakness of the legs, arms, or other locations

These symptoms slowly get worse and also are generally felt ~ above both sides of the body.

As the an illness worsens, symptoms might include any kind of of the following:

Decreased visionSleepinessFalls early to negative balance

The health care provider will do a physical exam. The exam usually reflects muscle weakness and also sensation difficulties on both political parties of the body, specifically in the legs. Knee jerk reflexes room often diminished or lost. Muscles may have spasticity. There may be lessened senses of touch, pain, and temperature.

Mental changes selection from mild forgetfulness to significant dementia or psychosis. Significant dementia is uncommon, however in some cases, that is the very first symptom that the disorder.

An eye exam might show damages to the optic nerve, a condition called optic neuritis. Indications of nerve inflammation may be seen during a retinal exam. There may additionally be abnormal pupil responses, loss of sharp vision, and also other changes.

Blood exam that might be bespeak include:


Vitamin B12 is given, normally by injection into a muscle. Injections are often given once a day for a week, then weekly for about 1 month, and also then monthly. Vitamin B12 supplements, either by injection or high-dose pills, must continue throughout life to prevent symptoms native returning.


Early treatment improves the opportunity of a an excellent outcome.

How well a human does relies on exactly how long they had actually symptoms before receiving treatment. If treatment is received within a few weeks, complete recovery may be expected. If therapy is delay for much longer than 1 or 2 months, full recovery might not it is in possible.

Untreated, SCD outcomes in continued and permanent damage to the nervous system.


Call her provider if abnormal sensations, muscle weakness, or other symptoms the SCD develop. This is an especially important if girlfriend or a household member has had actually pernicious anemia or various other risk factors.


Some vegetarian diets, especially vegan, might be low in vitamin B12. Acquisition a complement can assist prevent SCD.


Pytel P, Anthony DC. Peripheral nerves and also skeletal muscles. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic basis of Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 27.

So YT. Deficiency diseases of the worried system. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley"s Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 85.

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Updated by: Alireza Minagar, MD, MBA, Professor, department of Neurology, LSU health and wellness Sciences Center, Shreveport, LA. Additionally reviewed by David Zieve, MD, MHA, clinical Director, Brenda Conaway, Editorial Director, and also the A.D.A.M. Editorial team.


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