It is a neurodegenerative disease of the posterior and lateral columns of the spinal cord caused by a deficiency of certain hematopoietic factors and vitamin B12, sometimes also affecting the peripheral nerves. Clinically, it is mainly manifested by pyramidal tract damage and deep sensory disturbances, often accompanied by pernicious anemia.

bubble_chart Diagnosis

1. History and Symptoms

The onset is slow and progressively developing. Early symptoms often include pallor, fatigue, anemia, and indigestion. History initial stage [first stage]: Paresthesia in the extremities gradually affects both lower limbs, leading to weakness, unsteady gait, clumsy movements, and a sensation of tightness around the chest and abdomen.

2. Physical Examination Findings

For those with predominant damage to the posterior and lateral columns of the spinal cord, the lower limbs exhibit upper motor neuron paralysis, increased muscle tone, hyperactive tendon reflexes, and positive pathological reflexes; sensory disturbances: decreased or absent joint position sense and vibration sense below the level of the lesion, sensory ataxia. late stage [third stage]: Bladder and rectal dysfunction may occur.

3. Auxiliary Examinations

1. Peripheral blood and bone marrow examination reveal macrocytic hyperchromic anemia;

2. Plasma vitamin B12 levels are usually below 100ug/ml.

3. Gastric juice analysis may reveal achlorhydria resistant to histamine.

4. Lumbar puncture cerebrospinal fluid examination is mostly normal.

5. Spinal MRI may reveal abnormal signals in the degenerated segments of the spinal cord.

4. In the absence of anemia, it is sometimes necessary to differentiate from spinal cord compression and multiple sclerosis.

1. Correcting anemia: Vitamin B₁₂ 200-500ug intramuscular injection once daily for two weeks, followed by 200-500ug weekly for the next two months. Folic acid 0.1 orally three times daily.

2. Neurotrophic drugs: Citicoline 250-500mg intramuscular injection once daily. Coenzyme Q10 10mg intramuscular injection once daily.

3. Combined with physical therapy and acupuncture to improve limb weakness and ataxia.