Disease | Presentation | Other | Treatment |
B12 deficiency (subacute combined degeneration of spinal cord) | - Affectsdorsal column + corticospinal tract + peripheral nerves, causing significant ataxia along with upper and lower motor neuron weakness - Also causes – Megaloblastic anemia – Gastrointestinal symptoms – Dementia – Depression | - High levels of methylmalonic acid (MMA) → damages myelin | B12 injections or oral administration |
- Affects dorsal column > cerebellar tract > corticospinal tract leading to: – Ataxia – Nystagmus – Speech disturbance – Minimal weakness - Associated with scoliosis, heart disease, diabetes | - Autosomal recessive (expansion of GAA triplet reduces expression of mitochondrial protein frataxin) | 1. No truly effective treatment 2. Speech therapy/physical therapy 3. Treat the associated symptoms and diseases | |
Tabes dorsalis or syphilitic myelopathy | - Dorsal column dysfunction (typical gait) + peripheral nerves - Weakness/paresthesias (often painful)/degeneration of the joints - Argyll Robertson pupil and visual disturbances - Personality changes/dementia/deafness/loss of bladder control | - The clinical manifestations may be delayed for many years. - There is demyelination caused by untreated Treponema pallidum infection (tertiary syphilis) | 1. IV penicillin 2. Treat the pain (opiates and carbamazepine) 3. Physical therapy |
- Dorsal column: proprioception, vibration, discriminative touch.
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