Most investigators agree that the clinical entity known as subacute combined degeneration or subacute funicular myelitis is not a true system disease, but that the disease process begins in numerous more or less irregularly distributed foci, which later coalesce.
Shimozono1 and Wohlwill,2 employing modern methods, attempted to establish the sequence of the disease process. Their aim was to discover the structural unit which first suffers. They claim that the axis cylinder is first attacked and that the other changes are secondary.
Shimozono studied three cases of pernicious anemia and a number of experimental animals in which severe anemia was produced by the injection of pyrodin. He concluded that the disease process was mainly neurolytic. He describes the axis cylinder changes as occurring in three distinct phases. First, there is slight swelling in the axis cylinder leading to irregularities in its outline; second, there is loss of staining properties
GLOBUS JH, STRAUSS I. PROGRESSIVE FUNICULAR MYELOPATHY (SUB-ACUTE COMBINED DEGENERATION). Arch NeurPsych. 1922;8(4):366–378. doi:10.1001/archneurpsyc.1922.02190160027002
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