Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2016; 22(37): 8435-8438
Published online Oct 7, 2016. doi: 10.3748/wjg.v22.i37.8435
Ataxic gait following total gastrectomy for gastric cancer
Chang Ho Hwang, Dong Jin Park, Gyu Yeol Kim
Chang Ho Hwang, Department of Physical Medicine and Rehabilitation Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
Dong Jin Park, Gyu Yeol Kim, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board Standards University of Ulsan College of Medicine.
Informed consent statement: This patient provided informed consent before participation.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Gyu Yeol Kim, MD, PhD, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, South Korea.
Telephone: +82-52-2507000 Fax: +82-52-2508071
Received: June 13, 2016
Peer-review started: June 16, 2016
First decision: July 12, 2016
Revised: July 21, 2016
Accepted: August 8, 2016
Article in press: August 8, 2016
Published online: October 7, 2016

A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal. This was followed by weekly intramuscular injections of vitamin B12 for another 2 wk and oral administration of vitamin B12 three times per day. After comprehensive rehabilitation for 4 wk, she showed sufficient improvements in strength and ataxic gait, enabling her to return to her normal daily activities.

Keywords: Subacute combined degeneration, Vitamin B12 deficiency, Total gastrectomy, Gastric cancer

Core tip: Subacute combined degeneration (SCD) of the spinal cord is defined as the degeneration of the posterior and lateral columns of the spinal cord due to vitamin B12 deficiency. Because vitamin B12 deficiency can occur after total gastrectomy, so can SCD. Postoperative assessments have focused on the recurrence of gastric cancer after surgery, with fewer studies focusing on vitamin B12 deficiency, especially because SCD is a long-term complication. This report describes a patient who developed SCD after total gastrectomy for gastric cancer. SCD due to vitamin B12 deficiency should be suspected in patients showing gait disturbance after gastrectomy, even as a long-term complication.