Subacute combined degeneration of the spinal cord in a Nigerian child: a need for a high index of suspicion

Abstract

Background: Vitamin B12 deficiency has been reported to be associated with a spectrum of neurological disorders among which is subacute combined degeneration of the spinal cord.

Method: We report a case of subacute combined degeneration of the spinal cord secondary to vitamin B12 deficiency and discussed the clinical presentation and management challenge.

Result: The diagnosis was made through a high index of suspicion when the clinical presentation ranked highly with the mode of presentation of Vitamin B12 deficiency. Patient responded well to parentheral vitamin B12 preparation but subsequently defaulted from follow up for 8 years after which he represented with paraparesis and urinary incontinence. He was managed again with parentheral vitamin B12 preparations with good outcome and total resolution of symptoms at discharge.

Conclusion: A high index of suspicion is needed in identifying vitamin B12 deficiency related paraparesis in paediatric practice while the need for indefinite treatment and follow up is hereby emphasized.

Keywords: Vitamin B12 deficiency; myelinopathy; paraparesis; subacute combined degeneration