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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