A 73-year-old woman with chronic renal vascular disease developed over six months increasing spastic weakness of the legs, followed by rapid deterioration with marked spastic paraplegia, urinary retention, and posterior column deficit. Bone marrow exhibited mild changes suggested of vitamin B12 or folic acid deficiency; the former was excluded. At autopsy the spinal cord changes were those of subacute combined degeneration. Although studies of folate metabolisms were incomplete, there is reason to believe, on the basis of this and other reported cases, that folate deficiency may on occasion be responsible for neurological deficits.
Folate deficiency; subacute combined degeneration; myelopathy, nutritional deficiency.
Robertson DM, Dinsdale HB, Campbell RJ. Subacute Combined Degeneration of the Spinal CordNo Association With Vitamin B12 Deficiency. Arch Neurol. 1971;24(3):203–209. doi:10.1001/archneur.1971.00480330031002