Irreversible subacute sclerotic combined degeneration of the spinal cord in a vegan subject

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 23; no. 7; pp. 622 - 624
• Main Authors: Brocadello, Filippo, M.D, Levedianos, Giorgio, M.D, Piccione, Francesco, M.D, Manara, Renzo, Francini Pesenti, Francesco, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2007; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Blood; Dairy products; Diet; Diet, Vegetarian; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; human nutrition; Humans; long term effects; Magnetic Resonance Imaging - methods; Male; Middle Aged; nervous system diseases; Neurodegenerative Diseases - diagnosis; Neurodegenerative Diseases - drug therapy; Neurodegenerative Diseases - etiology; Neurologic syndrome; nutrient deficiencies; Paralysis; physical fitness; Plasma; spinal cord; Spinal Cord - pathology; Spinal Cord Diseases - diagnosis; Spinal Cord Diseases - drug therapy; Spinal Cord Diseases - etiology; Subacute sclerotic combined degeneration of the spinal cord; subacute toxicity; Veganism; Vegetarian diet; Vegetarianism; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin B 12 - therapeutic use; Vitamin B 12 Deficiency - complications; Vitamin B 12 Deficiency - drug therapy; Vitamin B Complex - therapeutic use; Vitamin B12; vitamin deficiencies; Vitamin B12; Subacute sclerotic combined degeneration of the spinal cord; Neurologic syndrome; Vegetarian diet; Human; Sensitivity disorder; Nervous system diseases; Spinal cord; Motor system disorder; Central nervous system; B-Vitamins; Cyanocobalamin; Vertebrata; Mammalia; Subacute combined degeneration of the spinalcord; Pyramidal syndrome; Central nervous system disease; Neurological disorder; Spinal cord disease
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2007.05.006

Abstract Objective We describe a case of irreversible subacute sclerotic combined degeneration of the spinal cord in a Western vegan subject. Methods A 57-y-old man, member of a vegan cult for 13 y, developed weakness, paraplegia, hyper-reflexia, distal symmetric muscular hypotrophy, impairment of superficial sensation in the hands and feet, loss of deep sensation in the lower limbs, and neurogenic bladder and bowel. Magnetic resonance imaging of the cervical and dorsal spine disclosed abnormally increased signal intensity on T2 -weighted sections in the posterior and lateral columns. Subacute sclerotic combined degeneration of the spinal cord was diagnosed and treatment with cobalamin was started. Results Despite rehabilitative treatment, the patient developed spastic hypertonia with mild improvement of paresthesias. Six months later, vitamin B12 plasma levels and hematological analysis were normal. One year later, spastic paraplegia was still present and the patient was unable to walk despite improvement on magnetic resonance imaging. Conclusion Irreversible subacute sclerotic combined degeneration of the spinal cord is a rare but possible effect of a strict vegetarian diet.