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Introduction Vitamin B12 deficiency is a systemic disease that often affects the nervous system and one of the most prevalent manifestations is Sub-acute Combined Degeneration of the Spinal Cord SACD which is encountered regularly by neurologists It primarily affects the posterior and lateral columns of the spinal cord white matter resulting in paraesthesia ataxic gait and loss of vibration and proprioception sense Metz 1992 The details of which will be discussed later in the paper SACD of the cord is a classic disease affecting approximately 1 out of 10000 people it was a frequent complication of pernicious anaemia before effective treatment with raw liver or vitamin B12 became available In recent years it has become a rare condition owing to earlier recognition and treatment of pernicious anaemia Vitamin B12 is abundant in meat fish and most animal by-products with vegetables being devoid of this vitamin Patten 1996 Accordingly strict vegetarians have long been known to be at risk of vitamin B12 deficiency which develops insidiously over many years As well it is now clear that a significant number of the elderly and HIV positive individuals are also at increased risk of deficiency Any individual with reduced ability to split cobalamin from food-protein may also become deficient even though intrinsic factor is present Markle 1996 SACD has numerous aetiologies such as malnutrition eg a strict vegetarian diet malabsorption eg pernicious anaemia Crohns disease tapeworm infestation nitrous oxide poisoning gastrectomy lack of intrinsic factor and from a genetic defect of particular coenzymes Lindsay and Bone 1997 Being appropriate as a nutrition essay I will concentrate on the dietary-nutritional lack of Vitamin B12 although to truly understand the condition in a more encompassing manner other aetiologies will need to be taken into account Although the role of malnutrition in the occurrence of SACD of the cord is rare it is still a possible aetiology that if overlooked or unknown can lead to dire consequences
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