Published online Oct 7, 2016. doi: 10.3748/wjg.v22.i37.8435
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.
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.