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Table 2 Laboratory values before and 11 month after cobalamin substitution

From: Rapid healing of a patient with dramatic subacute combined degeneration of spinal cord: a case report

  Before cobalamin substitution 11 month after cobalamin substitution Normal range
Cobalamin (pg/ml) 197 410 150–900
Homocysteine (µmol/l) 50.8 6.9 5.0–15.0
Methylmalonic acid (nmol/l) 40,800 178 50–300
Folic acid (ng/ml) 18.7 10 3–20
Gastrin (pg/ml) 615 730 13–115
Parietal cell antibodies 1:640 ≤1:20
  1. Despite distinct clinical findings of a subacute combined degeneration of spinal cord (SACD) and a profound intramedullar lesion shown by MRI, cobalamin was still in the normal range before therapy started. In contrast, homocysteine and methylmalonic acid are suitable parameters for SACD diagnostic. Methylmalonic acid is the most specific marker of a cobalamin deficiency. Homocysteine is suitable for follow-up and therapy monitoring. Just 5 month after therapy start clinical symptoms were declining and all pathological changes found by MRI in the spinal cord disappeared