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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The clinical features of subacute combined degeneration of the spinal cord are based on:

  • symmetrical loss of posterior columns causing an ataxic gait
  • symmetrical upper motor neurone signs in the lower limbs with absent reflexes
  • other features:
    • peripheral sensory neuropathy
    • optic atrophy
    • dementia

Symptoms may include:

  • paraesthesiae
  • unsteadiness; perhaps severe enough to prevent walking
  • weakness
  • stiffness of legs

Signs include:

  • spasticity in legs
  • hyporeflexia at the knees
  • loss of ankle jerks
  • extensor plantar responses
  • impaired posterior column function

NB: there may also be a sphincter disturbance with a dilated hypotonic bladder and a loss of sense of bladder fullness.

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