Objective:

To present a rare case of Subacute Combined Degeneration (SCD) of the cervical spinal cord along with cognitive decline and expressive aphasia due to deficiencies of Vitamin B12 and Copper

Background:

Vitamin B12 and copper deficiency are known causes of myeloneuropathy, which can lead to progressive spastic paraparesis along with sensory abnormalities. Rarely have their combined deficiencies been reported in the same patient to cause encephalopathy with SCD.

Design/Methods:

Results:

An 83-year-old female, with a history of anemia, autoimmune hepatitis, hypothyroidism, rheumatoid arthritis, and depression, was admitted to the hospital after experiencing subacute cognitive decline, expressive aphasia, and recurrent falls. Additionally, she reported unintentional weight loss of over 30lb in 3 months, suspicious for an occult malignancy. None was found. Clinical examination revealed a frail patient with diffuse weakness, reduced muscle tone, hyperreflexia in the upper extremities, hyporeflexia in the lower extremities, and bilaterally upgoing toes. Vibratory sensation was diminished in the lower extremities, worse on the left. An MRI of the cervical spine showed T2 hyperintensity in the dorsal columns bilaterally, creating an inverted “V” appearance, from C2 to C5. Blood labs showed low Vitamin B12 levels at 208 (>400 pg/mL) and Copper levels at six (10-22 μmol/L) along with macrocytosis and leukopenia. She was diagnosed with SCD, and treatment with high-dose vitamin B12 and copper supplementation was initiated, which led to resolved symptoms over time.

Conclusions:

The patient's clinical presentation, laboratory findings, and subsequent symptom resolution with supplementation strongly highlight the importance of early recognition and treatment of nutritional deficiencies in complex neurological cases. We encourage checking copper levels even when B12 deficiency has already been found.