5 subacute combined degenerative elderly patients with hyperhomocysteinemia:case report and literature review
QIN Heyan
LI Yumeng
HU Shijun
HU Anquan
CHEN Feng
WANG Pengcheng
LIU Tao
Abstract：Objective To investigate the etiology,clinical features and treatment of subacute combined degeneration(SCD).Methods The clinical manifestations,test results,neuroelectrophysiology and spinal MRI of 5 elderly patients with SCD with definite diagnosis were analyzed,and the relevant literature was reviewed.Results 5 elderly patients with SCD were included,and the symptoms of each patient varied greatly.Laboratory test results indicated that vitamin B12 was significantly decreased and homocysteine(Hcy)was significantly increased in all 5 patients.3 patients had macrocytic hypochromic anemia.Serum anti-parietal cell antibody IgG and anti-internal factor antibody IgG were positive in 3 patients.2 patients tested positive for the methylenetetrahydrofolate reductase(MTHFR)gene.There were significant spinal MRI features in 3 patients,and no typical imaging findings in 2 patients.Among them,Hcy decreased to normal level after intramuscular injection of vitamin B12 and other treatments in 4 patients,and clinical symptoms of 5 patients were significantly improved after treatment.Conclusion SCD can occur in old age with insipid onset and is not always manifested as classic symptoms and signs.Vitamin B12 deficiency is usually the cause of the disease,and elevated Hcy can be used as a marker of vitamin B12 deficiency and keep pace with the disease changes.Treatment with vitamin B12 and folic acid supplementation is effective,and timely diagnosis and prognosis are better.
Keywords：subacute combined degenerationvitamin B12hyperhomocysteinemiaspinal MRIMTHFR gene
Publication Date：2025-10-28
Online Publishing Date：2025-10-09(First online date of this platform, not the publication date of the document)
Pages：6( 102-107 )