Subacute Combined Degeneration of the Spinal Cord and Hydrocephalus Associated with Vitamin B12 Deficiency

World Neurosurg. 2019 Aug:128:277-283. doi: 10.1016/j.wneu.2019.05.008. Epub 2019 May 10.


Background: This study aimed to report the case of a patient who presented with depression, cognitive impairment, ataxic gait, and urinary incontinence associated with vitamin B12 deficiency.

Case description: Serum vitamin B12 level was low in this patient, and anti-intrinsic factor antibody was positive. Neuroimaging revealed abnormal hyperintense signals in the cerebellum and dorsal and lateral columns of the spinal cord, and obstructive hydrocephalus. A biopsy of the stomach revealed chronic gastritis, intestinal metaplasia, and atrophy. After 3 months of initiating methylcobalamin therapy, significant improvement was noticed clinically, and brain magnetic resonance imaging was near to normal.

Conclusions: This study was novel in reporting subacute combined degeneration of the spinal cord and hydrocephalus associated with vitamin B12 deficiency in adults.

Keywords: Anti-intrinsic factor; Atrophic gastritis; Cerebellum; Hydrocephalus; Neuroimaging; Subacute combined degeneration; Vitamin B12 deficiency.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Gastritis, Atrophic / complications
  • Gastritis, Atrophic / immunology
  • Gastritis, Atrophic / pathology
  • Humans
  • Hydrocephalus / diagnostic imaging*
  • Hydrocephalus / etiology
  • Hydrocephalus / physiopathology
  • Intrinsic Factor / immunology
  • Male
  • Subacute Combined Degeneration / diagnostic imaging*
  • Subacute Combined Degeneration / etiology
  • Subacute Combined Degeneration / physiopathology
  • Vitamin B 12 / analogs & derivatives
  • Vitamin B 12 / therapeutic use
  • Vitamin B 12 Deficiency / diagnosis*
  • Vitamin B 12 Deficiency / drug therapy
  • Vitamin B 12 Deficiency / etiology
  • Vitamin B 12 Deficiency / physiopathology
  • Vitamin B Complex / therapeutic use


  • Vitamin B Complex
  • Intrinsic Factor
  • mecobalamin
  • Vitamin B 12