크론병 환자에서 강직성 하지마비로 발현한 아급성연합변성 1예
Subacute Combined Degeneration manifesting as Spastic Paraplegia in Cronh’s Disease Patient: A Case Report
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Subacute combined degeneration (SCD) is a spinal cord disorder involving posterior and lateral columns due to vitamin B12 deficiency. We report a case of 39-year-old male with known Crohn’s disease and subsequent ileocecectomy, who showed progressive spastic paraplegia. Neurologic examination revealed predominant feature of spastic paraplegia with scissor gait and bilateral hyperreflexia, associated with psychomotor slowing, poor vibration sense of both distal legs. Spinal MRI revealed high signal intensities in upper thoracic spinal cord, and tibial SEP revealed central conduction delays. VEP study showed bilateral prolonged P100 latencies. Serum vitamin B12 level was low (191.9 pg/mL). After parenteral administration of vitamin B12, his neurologic symptoms rapidly improved. His neurologic symptoms are believed to be the result of vitamin B12 deficiency due to previous ileocecectomy. Vitamine deficiency should be ruled out as a cause of neurologic complications in patients with malabsortive condition even when the neurological manifestation is atypical.
Abstract
Subacute combined degeneration (SCD) is a spinal cord disorder involving posterior and lateral columns due to vitamin B12 deficiency. We report a case of 39-year-old male with known Crohn’s disease and subsequent ileocecectomy, who showed progressive spastic paraplegia. Neurologic examination revealed predominant feature of spastic paraplegia with scissor gait and bilateral hyperreflexia, associated with psychomotor slowing, poor vibration sense of both distal legs. Spinal MRI revealed high signal intensities in upper thoracic spinal cord, and tibial SEP revealed central conduction delays. VEP study showed bilateral prolonged P100 latencies. Serum vitamin B12 level was low (191.9 pg/mL). After parenteral administration of vitamin B12, his neurologic symptoms rapidly improved. His neurologic symptoms are believed to be the result of vitamin B12 deficiency due to previous ileocecectomy. Vitamine deficiency should be ruled out as a cause of neurologic complications in patients with malabsortive condition even when the neurological manifestation is atypical.
참고문헌 (5)
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