SUBACUTE COMBINED DEGENERATION OF THE SPINAL-CORD FROM FOLATE-DEFICIENCY

Subacute combined degeneration of the spinal cord is a rare neurologic complication of folate deficiency, Progressive gait disturbance, weakness, confusion, and depression developed in a 39-year-old man, He had taken phenobarbital for more than 2 years, He was bedbound, with new loss of position and vibration senses in the lower extremities, His hemoglobin was 2.9/dl, mean corpuscular volume 122 fl, vitamin B-12 428 pg/ml, and folate 1 ng/ml, Peripheral blood and bone marrow showed megaloblastic anemia, Serum methylmalonic acid and homocysteine levels were consistent with folate deficiency, not B-12 deficiency, Treatment with folate and packed erythrocytes resulted at 4 months in overall improvement, including walking, Position sense was restored, and vibration sense had become nearly normal, The authors found no cause for folate deficiency except phenobarbital.