| Background and purposeSubacute Combined Degeneration of the spinal cord（SCD）,also known as subacute combined degeneration,is a neurodegenerative disease of the nervous system caused by insufficient stores of vitamin B12 in the body due to various reasons（e.g.low intake,impaired absorption,etc.）.Clinically,patients usually present with ataxia（sensory）,limb numbness,deep limb sensory disturbances,gait abnormalities,and peripheral neuropathy.The posterior spinal cord and pyramidal tract are the main pathological sites of SCD,with severe involvement of the optic nerve,cerebral white matter,and peripheral nerves.SCD is often insidious and lacks typical clinical manifestations in its early stages,making it difficult to detect the disease promptly and making it easy to underdiagnose or even misdiagnose it.Therefore,early diagnosis and treatment of SCD are crucial.Although laboratory tests such as serum Vit B12 levels,hemoglobin（HGB）,homocysteine（HCY）,mean red blood cell volume（MCV）and spinal MRI can assist in the diagnosis,there are some patients with normal serum Vit B12 levels and early spinal MRI may not be abnormal.However,there are problems with some patients having normal serum Vit B12 levels and early spinal MRI may not be abnormal.A review of the data found that neurophysiology has significant advantages in defining the extent of lesions,finding subclinical lesions,and assessing the severity of the disease and it can be used as an indicator of improvement in neurological recovery in SCD at follow-up.This study,therefore,investigates the neurophysiological changes in patients with SCD,summarises the neurophysiological characteristics of patients with SCD,and improves clinicians’understanding of neurophysiology in patients with SCD.According to the literature search and review,there is still a lack of studies related to prognostic indicators of SCD,and thus a relative lack of information in assessing individual prognosis.In this study,we collected general information,onset triggers,past medical history,personal history,clinical manifestations,hematological examination,neurophysiological and spinal MRI features of 60 patients with SCD,and performed retrospective statistical analysis to assess relevant information affecting the prognosis of patients with SCD,to analyze and summarise risk factors related to prognosis affecting patients with SCD,and to grasp the severity of the disease.DATA AND METHODS:This study retrospectively analyzed the demographic data,onset triggers,past medical history,clinical features,physical signs,hematological examination,neurophysiology,and spinal cord MRI findings of 60 patients who were hospitalized and diagnosed with SCD at the Department of Neurology,Huaihe Hospital of Henan University from January 1,2018,to December 31,2022.SPSS22.0statistical software was applied for data analysis.Data of measurement data met normal distribution and were expressed by（`x±s）,and a t-test was used for comparison between the two groups;data did not meet normal distribution and were expressed by M（IQR）,and the Mann-Whitney U test was used for comparison between two groups;count data were expressed by n（%）,and the chi-square test or Fisher The exact probability method was used to analyze the influencing factors leading to poor prognosis by logistic regression,and the difference was statistically significant by the test level p<0.05.（1）Based on the clinical data collected,the general profile,etiology,past medical history,clinical presentation,haematological examination,spinal MRI and especially neurophysiological features of SCD patients were summarised.（2）Patients were divided into a good prognosis group（neurological dysfunction score<4）and a poor prognosis group（neurological dysfunction score≥4）according to their neurological dysfunction score at discharge,and the relevant factors affecting the poor prognosis of patients were analyzed.RESULTS:The data of 60 patients with SCD in this study included 33 male patients（55.0%）and 27female patients（45.0%）;22 patients（36.7%）were less than or equal to 50 years of age and 38 patients（63.3%）were older than 50 years of age)Duration of disease:mean 2.68 months,median（interquartile）1（0.5,2.75）;Occupational composition:occupation The highest proportion of patients（68.3%）were farmers or freelancers in 41 cases,followed by retired in 10 cases（16.7%）and others in 9 cases（15.0%）;Causes of morbidity included gastrointestinal diseases（atrophic gastritis,erosive gastritis,etc.）in 8 cases（13.3%）,unbalanced diet in 16 cases（26.7%）,chronic heavy alcohol consumption in 17 cases（28.3%）,chronic heavy smoking in 17 cases（28.3%）,and history of N2O inhalation in 0 cases（0%）.The first presentation was numbness of the limbs in 32 cases（53.3%）,weakness of the limbs in 29 cases（29.0%）,unsteadiness of walking in 32 cases（53.3%）,numbness of the limbs with weakness in 11 cases(18.3 Previous history characteristics:the highest proportion of patients with gastrointestinal diseases was 14（23.3%）,17（28.3%）with hypertension,7（11.7%）with coronary atherosclerotic heart disease and 2（11.7%）with type 2 diabetes mellitus.There were 2 cases（3.3%）with a history of type 2 diabetes mellitus and 5 cases（8.3%）with a smaller proportion of other cases,specifically 1 case of hypothyroidism,1 case of depression,1 case of tuberculosis,1 case of multiple sclerosis and 1 case of cerebral infarction;physical examination:20 cases（33.3%）with sensory planes,9 cases（33.3%）with positive Romerg’s sign,36.7%with Babinski’s sign and30.0%with abnormal muscle strength.In laboratory tests,HGB was decreased in 32 cases（53.3%）,MCV was increased in 33 cases（55.0%）,HCY was increased in 37 cases（61.7%）,serum Vit B12 was decreased in37 cases（61.7%）,FA was decreased in 13 cases（21.7%）,thyroid function was abnormal in 9 cases(55.0 The number of motor nerve abnormalities was significantly less than the number of sensory nerve abnormalities.29 patients did not elicit the H-reflex,10 patients（58.8%）could elicit the abnormal H-reflex,and 42 patients（91.3%）had abnormal F-waves.There were 42 cases（91.3%）with abnormal F waves and 2 cases（3.3%）with abnormal needle polarity electromyography（EMG）.The total number of motor nerves measured was 84for the upper limb nerves（median and ulnar nerves）and 92 for the lower limb nerves（common tibial and peroneal nerves）,with 10（5.7%）abnormal motor nerve wave amplitudes and 16（9.0%）abnormal nerve conduction velocities（m/s）,The number of abnormal sensory nerve wave amplitude was 102（60.0%）,and the number of abnormal nerve conduction velocity（m/s）was 94（53.4%）,totaling 102 abnormal nerves（60.0%）.The spinal cord MRI examination:50 patients with complete cervical MRI examination,18 patients with abnormalities（36%）,45 patients with complete thoracic MRI examination,and 12 patients with abnormalities（26%）.Logistic univariate regression analysis of good prognosis compared with poor prognosis showed no significant differences between groups in terms of gender,occupation,first symptoms,Vit B12 level,and previous chronic diseases;while there were no significant differences between groups in terms of the sensory plane,Babinski’s sign,age,duration of illness,anemia,neurological condition,and time of illness,There were statistically significant differences between the groups in terms of sensory planes,Babinski’s sign,age,duration of illness,anemia and neurophysiological conduction.A multifactorial analysis using logistic regression analysis of the above possible risk factors suggested that long duration of illness,presence of sensory planes,and positive Babinski’s sign were independent risk factors for poor prognosis in SCD patients.Conclusions:1.The age of onset of SCD is predominantly over 50 years old;the first symptoms are mainly numbness and weakness of the limbs;the positive signs on examination include abnormal muscle strength;the cause of onset is closely related to the absorption and metabolism of Vit B12.2.Neurophysiological examination plays an important role in the diagnosis of SCD:sensory nerve involvement is common,and the involvement of the lower limbs is more obvious.3.The prognosis of patients with SCD who have a long course of the disease and who present with positive sensory planes and Babinski’s sign is poor. |
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