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CPE-009 · Safety
B12-06: Pattern of subacute combined degeneration
Pattern of subacute combined degeneration. Evaluates posterior-column signs (loss of vibration or proprioception, positive Romberg) or gait ataxia.
Condition
- posterior-column signs (loss of vibration or proprioception, positive Romberg) or gait ataxia
- with spasticity or Babinski sign, or with ascending sensory symptoms
What it reports
- Urgent: neurologic pattern compatible with vitamin B12-related subacute combined degeneration
Diagnostic boundary
- Time-sensitive: irreversible damage can follow delay. The engine names no treatment.
Evidence
- EV-BSH-2014Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.Supports: Diagnostic approach with serum B12, MMA and homocysteine Neurologic involvement means treatment should not wait for confirmation Folic acid alone must not be given while B12 deficiency is unexcluded
- EV-STABLER-2013Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160.Supports: Clinical presentations, subacute combined degeneration, nitrous oxide and drug causes
Cases where this rule fires
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