Funicular Degeneration of the Spinal Cord Without Pernicious Anemia

Woltman, Henry W.; Heck, Frank J.

doi:10.1001/archinte.1937.00180020096008

Cited by 30 publications

(3 citation statements)

References 53 publications

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“…When megaloblastic anaemia occurs in patients with idiopathic steatorrhoea it is usually attributed to lack of folic acid. A deficiency of vitamin B12, however, is not uncommon (Mollin & Ross, 1954) and in some cases subacute combined degeneration may develop (Woltman & Heck, 1937). T h e absorption of labelled vitamin B,, in this disease may be normal, grossly impaired or between these extremes.…”

Section: Discussionmentioning

confidence: 94%

The absorption of vitamin B₁₂ in the megaloblastic anaemias

Evans¹

1956

Proc. Nutr. Soc.

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Section: Discussionmentioning

confidence: 94%

The absorption of vitamin B₁₂ in the megaloblastic anaemias

Evans¹

1956

Proc. Nutr. Soc.

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“…A small number of case reports of patients with presumed CD and neurological manifestations (Elders, 1925;Reed and Ash 1927;Woltman and Heck 1937) were published prior to the discovery of the aetiological agent and the introduction of small bowel biopsy. Such reports need to be treated with caution given that a diagnosis of CD in those patients was speculative.…”

Section: Introductionmentioning

confidence: 99%

The Neuroimmunology of Gluten Intolerance

Hadjivassiliou

Sanders

Aeschlimann

2016

Neuro-Immuno-Gastroenterology

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The term Gluten Related Disorders (GRD) denotes a spectrum of diverse immune mediated diseases triggered by the ingestion of gluten (protein found in wheat, barley and rye). Coeliac disease (CD) or gluten sensitive enteropathy is the most recognised and studied entity within GRD.Extraintestinal manifestations, are gaining recognition and are increasingly the subject of further studies as they may hold the key to unravelling the pathophysiology of GRD. Such manifestations include skin involvement in the form of dermatitis herpetiformis (DH) and neurological dysfunction (eg gluten ataxia and gluten neuropathy). Furthermore the recent concept of extraintestinal manifestations without enteropathy (termed Non-Coeliac Gluten Sensitivity-NCGS) has become accepted as part of the same spectrum. In this chapter we review the neurological manifestations in GRD, discuss recent advances in diagnosis, and possible pathophysiological mechanisms.

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“…It can also occur in association with fish-tapeworm infestation, particularly in Scandinavia (Woltman and Heck, 1937). A much rarer cause of subacute combined degeneration is when it is due entirely to dietary deficiency of vitamin B12.…”

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confidence: 99%

Unusual case of subacute combined degeneration of spinal cord.

Riley¹

1966

BMJ

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Subacute combined degeneration of the cord classically occurs in association with Addison's pernicious anaemia. Over the years improved haematological and biochemical techniques have shown that it can occur in vitamin-B.2-deficiency states other than pernicious anaemia: these include cases following gastrectomy, in which most of the intrinsic-factor-producing area may be removed, and in other cases of " malabsorption syndrome."It can also occur in association with fish-tapeworm infestation, particularly in Scandinavia (Woltman and Heck, 1937 COMMENTThese results thus showed that he was in fact deficient in vitamin B2 and so supported our diagnosis of subacute combined degeneration. The presence of free hydrochloric acid in the stomach rules out classical pernicious anaemia and the Schilling test showed that he was able to absorb vitamin B12* Thus it seemed virtually certain that his deficiency was due to an inadequate intake of vitamin B12 as a result of his most unusual diet.Surprisingly there was no anaemia, but the high fasting serum iron and early marrow changes suggested that this might have been imminent. Megaloblastic anaemia due to dietary deficiency of vitamin B12 has been recorded previously in vegans and old people existing on very precarious diets (Harrison et al., 1956;Bourne and Oleesky, 1960). In this case the relatively high intake of folic acid was probably the reason why the subacute combined degeneration developed before the anaemia.Though this neurological complication as a result of dietary deficiency has been previously reported, and reviewed by Richmond and Davidson (1958), this case seems unique in that the patient was not in the strictest sense either a vegan or a vegetarian. It was simply a food fad carried over from his younger days. Badenoch's (1954) case was similar, though his patient was described as a vegetarian. This patient's diet contained none of the usual sources of vitamin B L2' Animal protein in the form of meat and fish being the main sources, his diet had lacked both, apparently for most of his life.As he originally had no intention of changing his dietary habits we thought it safer to treat him with vitamin-B,1 iniections. On this treatment, though his symptoms have improved, the neurological signs remain virtually the same, except that the plantar responses are probably now flexor. However, his appetite improved so much that he eventually started, and is continuing to take, a normal diet, and his weight has increased from 9 st. 7 lb. to 10 st. 8 lb. (4.28 to 4.76 kg.). As we know he is able to absorb vitamin B12, we have now discontinued his injections.

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Funicular Degeneration of the Spinal Cord Without Pernicious Anemia

Cited by 30 publications

References 53 publications

The absorption of vitamin B₁₂ in the megaloblastic anaemias

The absorption of vitamin B₁₂ in the megaloblastic anaemias

The Neuroimmunology of Gluten Intolerance

Unusual case of subacute combined degeneration of spinal cord.

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Funicular Degeneration of the Spinal Cord Without Pernicious Anemia

Cited by 30 publications

References 53 publications

The absorption of vitamin B12 in the megaloblastic anaemias

The absorption of vitamin B12 in the megaloblastic anaemias

The Neuroimmunology of Gluten Intolerance

Unusual case of subacute combined degeneration of spinal cord.

Contact Info

Product

Resources

About

The absorption of vitamin B₁₂ in the megaloblastic anaemias

The absorption of vitamin B₁₂ in the megaloblastic anaemias