Subacute combined degeneration associated with vitamin E deficiency due to small bowel obstruction: A case report
- Abstract
- Rationale: There have been a few reported cases of subacute combined degeneration (SCD) associated with vitamin E deficiency,
but the period of intestinal malabsorption was more than several years. We present a rare case of acute onset SCD that occurred in a
relatively short period of several weeks with vitamin E deficiency related to small bowel obstruction.
Patient concerns: A 50-year-old woman had abdominal pain. A small bowel obstruction was suspected and conservative
treatment was performed. She underwent bowel surgery after 2 weeks without any improvement. Following the operation, she was in
a state of reduced consciousness. She was treated in an intensive care unit. Her consciousness level gradually recovered to alert in a
week, but other symptoms such as ataxia, weakness on limbs, severe dysarthria, and dysphagia occurred. Since then, she had
spent nearly 6 weeks in a bed-ridden state without improving.
Diagnosis: SCD associated with vitamin E deficiency was confirmed by laboratory investigations, electrophysiologic test, and
whole spine magnetic resonance imaging scans.
Interventions: For vitamin E supplementation, she was administered a dose of 1200mg/d. Physical therapy was focused on
strengthening exercise, balance, and walker gait training. Occupational therapy was focused on activities of daily living training and
dysphagia rehabilitation.
Outcomes: After 6 weeks, her muscle strengths and functional level were substantially improved. The vitamin E level was
recovered to normal range.
Lessons: This case suggests that if neurological symptoms occur in patients with intestinal obstruction, clinicians need to consider
a deficiency of micronutrients such as vitamin E and vitamin B12. Patients with short clinical courses suffer less neurological damage
and achieve faster recovery.
- All Author(s)
- J. B. Jung
; Y. Kim
; K. Oh
; S. A. Kim
; J. H. Doh
; H. J. Oh
; J. M. Seok
- Issued Date
- 2019
- Type
- Article
- Keyword
- ataxia; intestinal obstruction; malabsorption; subacute combined degeneration; vitamin E deficiency
- Publisher
- Lippincott Williams & Wilkins
- ISSN
- 0025-7974
; 1536-5964
- Citation Title
- Medicine
- Citation Volume
- 98
- Citation Number
- 36
- Citation Start Page
- e17052
- Citation End Page
- e17052
- Language(ISO)
- eng
- DOI
- 10.1097/md.0000000000017052
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/2452
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