title: Irreversible subacute sclerotic combined degeneration of the spinal cord in a vegan subject.
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 T(2)-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.
  
  
  CONCLUSIONS
  Irreversible subacute sclerotic combined degeneration of the spinal cord is a rare but possible effect of a strict vegetarian diet.
authors.affiliation: Clinical Nutrition Unit, Azienda Ospedaliera of Padua, Padua, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Brocadello
authors.forename: Giorgio
authors.initials: G
authors.lastname: Levedianos
authors.forename: Francesco
authors.initials: F
authors.lastname: Piccione
authors.forename: Renzo
authors.initials: R
authors.lastname: Manara
authors.forename: Francesco Francini
authors.initials: FF
authors.lastname: Pesenti
mesh_terms: D014676:Diet, Vegetarian; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D013116:Spinal Cord / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D014805:Vitamin B 12 / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000188:drug therapy; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex; D014805:Vitamin B 12