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Abstract Details

Two to Tango: Subacute Combined Degeneration with Encephalopathy due to Deficiency of B12 and Copper
General Neurology
P4 - Poster Session 4 (11:45 AM-12:45 PM)
4-011
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
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.

Review of medical records of a patient with ataxia and encephalopathy.
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 鈥淰鈥 appearance, from C2 to C5. Blood labs showed low Vitamin B12 levels at 208 (>400 pg/mL) and Copper levels at six (10-22 碌mol/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.
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.
Authors/Disclosures
Muhammad I. Yousaf, MD
PRESENTER 		Dr. Yousaf has nothing to disclose.
Mohammad R. Ghani, MD Dr. Ghani has nothing to disclose.
Rana Usman Anwar (Nishtar Medical University, Pakistan) Rana Usman Anwar has nothing to disclose.
Victoria N. Holiday, MD (University of Louisville College of Medicine) Dr. Holiday has nothing to disclose.
Martin E. Brown, MD (University of Louisville) Dr. Brown has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Brown has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Brown has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx. Dr. Brown has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx. Dr. Brown has received personal compensation in the range of $100,000-$499,999 for serving as a Neurologist with University of Louisville.