A CASE OF SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD WITH INTERESTING HEREDITARY FEATURES

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Abstract
Pernicious anemia and subacute combined degeneration were diagnosed in a man aged 22 who on entrance was moribund, completely paralyzed in both legs, and psychotic. His mother and a paternal uncle had had the same combination of illnesses. Four mos. after admission he had been returned to work, with no visible gait disturbance. Hyperreflexia, pathological reflexes, and impairment of vibratory and position sense in the legs persisted. This rapid improvement (which was sustained) was felt to be due to employment of massive doses of liver (Lederle''s concentrated liver extract, 3 cc. intramuscularly daily for the first 50 days), to the use of parenteral thiamin chloride, to the early initiation of massage, passive and active exercises, and reeducational walking exercises, and to the subsequent maintainence of the erythrocyte count above 5,000,000 per cu. mm. Hereditary data reviewed in this case suggested that pernicious anemia and subacute combined degeneration may have an hereditary basis, transmitted after the manner of a Mendelian recessive character, and with a tendency to occur at progressively earlier ages in successive generations.

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