Subacute Combined Degeneration - CRASH! Medical Review Series

(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

[@midgetsmommy]

I lived through this, when I was diagnosed, I had no detectable B12. 4 Doctors thought I had mental problems because many of the symptoms seemed unrelated. Also, toward the end I had tics, stuttering, and much crying. There are more symptoms than you can almost imagine, and it was a long 1.5 years to full recovery if it is ever full after such a bad case. The Doctor who figured it out (with a simple blood test) said she never seen a case nor did my gynecologist when I went back. I have written my experience and often consider doing a video to help others who may have trouble getting a proper diagnosis.

[@susannechristiansen7132]

You should try to make a video 🙏 Did you have daily high dose vitamin B12 injections and are you still on frequent injections and is it for the rest of your life ?

[@buckshotat]

Dr Bolin. I love these videos. One small anatomy correction (which does not change any of the clinically relevant points you highlight): The dorsal column 1st order neurons (LMN) synapse in the medulla at the cuneate and graciles nucleus (not the dorsal horn as you state). I believe a quick pop up window would suffice to correct. Again great videos.

[@woloabel]

Neurology: Subacute Combined Degeneration (Aetiology is Vitamin B 12 Deficiency, or 1) Pernicious Anemia, 2) Celiac Disease, 3) Diphyllobothrium Latum Infection (Diphyllobothriasis), 4) HIV Infection and 5) Alcoholism) Also Malnutrition can be a cause of SCD. Pathophysiology is Loss of Fine Touch and Proprioception (Dorsal Column Medial Lemniscus [DCML]) and Lateral Corticospinal Tract (Motor Function Conduction and/or Innervation). It can be insidiously progressive if untreated by B 12 Replacement/Supplementation. SSx: 1) Distal Paresthesias (Low of Fine Touch and Vibration Sensations), 2) Numbness, 3) Tingling, 4) Fatigue (Anemia) and 5) Pallor. Dx: 1) Vitamin B12 Levels (Low Levels); 2) Methylmalonic Acid (MMA) and 3) Homocysteine Level Tests (Both will be Elevated). DDx: 1) Folate Deficiency (MMA Level Normal and Homocysteine High); 2) Tabes Dorsalis (Neurosyphylis), B12 Levels are Normal (MMA and HC Normal); 3) Multiple Sclerosis (MS). Symptomatology and B12 Levels are inconsistent with SCD. The latter two pathologies both have Vibratory Loss and Paresthesia. Tx: 1) Vitamin B12 Replacement, 2) Treatment of Underlying Aetiology (Celiac Disease or Tapeworm infection) or Predisposing Cause (Alcoholism with Psychotherapy/Behavior Modification). Goodness, I had no idea tapeworms where so Pernicious. MD Paul Bolin, es immer geht gut zu Gesundheit machen uberall. Prost!

[@uttamkumar097]

absolutely great doc you are probably the best lecturer on earth..

[@giseleschinaider2336]

Thank you so much for the neurology videos

[@DrDinooshDeLivera]

The histological cross-section of the spinal cord has a lateral horn, therefore it's a section either from TI - L2 or from S2 - S4.

[@femidaelettil1002]

Thanks.. Lateral horn corresponds to autonomic system?

[@DrDinooshDeLivera]

Very informative, thank you!

[@jacobkom5249]

Great presentation Dr Bolin, I might just add that the science journalist you showed at 20:51 is actually an acclaimed medical journalist and Medical Doctor in the UK (en.wikipedia.org/wiki/Michael_Mosley_(broadcaster).

[@eelivia]

Jacob Kom Yeah! I've seen his medical documentaries and they are very interesting.

[@drjuhipt9535]

Thanks. Very informative & interesting medical videos

[@TheEmmd]

why is there a dislike?? perhaps a Post-traumatic stress patient from a Digital Rectal exam disliked this..

[@DrDinooshDeLivera]

Jealousy is a disease.

[@grayautumnday]

I ended up with fairly advanced SCD because I had normal B12 blood levels the whole time, despite megaloblastic anemia and central neuropathy in hands and feet. I had to be diagnosed when ataxia got severe by the specific pattern of demyelination and cord degeneration on my c-spine on fMRI. Recently, I've discovered that I have heterozygous mutations known for interfering with intracellular cobalamin metabolism, and I've thought that might be why I had normal b12 levels

[@awdawdawdawd3511]

Hi, i like your videos, but i don't think it's correct to refer to the lower part of the medulla oblongata as "the lower part of the medulla", since you have the "medulla spinalis" below this. I understand how it wouldn't seem confusing to english-speakers who refer to the "medulla spinalis" as the "spinal cord", but keep in mind, that rhetorically you are refering to "the core" - of which you have plenty below the oblongata. To me it seems confusing, since i'm used to the latin terms and therefore "the medulla" ends in the cauda equina. Kind regards, Bjørn Wiegell, Denmark

[@pwbmd]

awdawdawdawd Thanks for pointing that out! Yes, we don't use the term medulla spinalis. "Medulla" is typically used interchangeably with medulla oblongata.

[@oscargarcia6831]

What about no alcoholism no drugs no malnutrition no high homocysteine but the Dr do not put attention to what I saying to him the symptoms are what you said?

[@beyonddrapery5179]

Too lengthy. make them short