72 Subacute combined degeneration of the spinal cord Instruction Carry out a neurological examination of the patient’s legs. Salient features History • Family history of pernicious anaemia • History of alcohol consumption and previous gastrectomy • History of chronic diarrhoea (Crohns’ disease, etc.) • Tingling distal paraesthesia (common presenting symptom) • Whether the patient is a vegan. Examination • Absent ankle jerks (caused by peripheral neuropathy and motor involvement) • Brisk knee jerks • Upgoing plantars (usually first evidence of spinal cord lesion) • Diminished light touch, vibration and posterior column signs • Romberg’s sign positive. Proceed as follows: • Examine: • mucous membranes for anaemia (pernicious anaemia) • abdomen for scars of previous gastrectomy (carcinoma of the stomach) • pupils (Argyll Robertson pupil (Case 39) because tabes is a differential diagnosis) • fundus for optic atrophy, seen in this condition. • Tell the examiner that you would like to do the following investigations: • Mini-mental status examination for dementia • A ‘red tongue and unsteady gait’ is seen in the classic condition. Diagnosis This patient has absent ankle jerks, brisk knee jerks and upgoing plantars with posterior column signs (lesion) caused by subacute combined degeneration of the spinal cord (aetiology) and paralysis (functional status). Questions Mention a few causes of vitamin B12 deficiency • Vegan diet • Impaired absorption: • from the stomach: pernicious anaemia, gastrectomy • from the small bowel: ileal disease, bacterial overgrowth, coeliac disease Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Subacute combined degeneration of the spinal cord Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access
72 Subacute combined degeneration of the spinal cord Instruction Carry out a neurological examination of the patient’s legs. Salient features History • Family history of pernicious anaemia • History of alcohol consumption and previous gastrectomy • History of chronic diarrhoea (Crohns’ disease, etc.) • Tingling distal paraesthesia (common presenting symptom) • Whether the patient is a vegan. Examination • Absent ankle jerks (caused by peripheral neuropathy and motor involvement) • Brisk knee jerks • Upgoing plantars (usually first evidence of spinal cord lesion) • Diminished light touch, vibration and posterior column signs • Romberg’s sign positive. Proceed as follows: • Examine: • mucous membranes for anaemia (pernicious anaemia) • abdomen for scars of previous gastrectomy (carcinoma of the stomach) • pupils (Argyll Robertson pupil (Case 39) because tabes is a differential diagnosis) • fundus for optic atrophy, seen in this condition. • Tell the examiner that you would like to do the following investigations: • Mini-mental status examination for dementia • A ‘red tongue and unsteady gait’ is seen in the classic condition. Diagnosis This patient has absent ankle jerks, brisk knee jerks and upgoing plantars with posterior column signs (lesion) caused by subacute combined degeneration of the spinal cord (aetiology) and paralysis (functional status). Questions Mention a few causes of vitamin B12 deficiency • Vegan diet • Impaired absorption: • from the stomach: pernicious anaemia, gastrectomy • from the small bowel: ileal disease, bacterial overgrowth, coeliac disease Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Subacute combined degeneration of the spinal cord Full access? Get Clinical Tree
