Question

A male patient presents with sensory loss and weakness of limbs for 3 months. He also has angular stomatitis. On examination, there is loss of proprioception, vibration sensations, UMN type of lower limb weakness, and absent ankle reflex. What is the most probable diagnosis?

• A. Extradural cord compression
• B. Amyotrophic lateral sclerosis
• C. Multiple sclerosis
• D. Subacute combined degeneration of cord

Answer 1

The Correct Option is D

The patient's presentation includes sensory loss, weakness of the limbs, angular stomatitis, loss of proprioception, vibration sensation, upper motor neuron (UMN) type of lower limb weakness, and absent ankle reflex. Let's break down these symptoms to determine the most probable diagnosis:

• Sensory Loss and Weakness: These symptoms can occur in various neurological conditions; however, the specific loss of proprioception and vibration sense points towards a neurological issue involving the dorsal columns of the spinal cord.
• Angular Stomatitis: This is often associated with vitamin deficiencies, particularly vitamin B12.
• UMN Weakness and Absent Ankle Reflex: The combination suggests involvement of both the corticospinal tract (for UMN signs) and the peripheral nerves or reflex arc (for the absent reflex).

The cluster of symptoms suggests damage involving multiple pathways within the nervous system: dorsal columns, corticospinal tracts, and possibly peripheral nerves. This pattern is characteristic of Subacute Combined Degeneration of the Cord, which is most commonly the result of vitamin B12 deficiency. The presence of angular stomatitis further supports a nutritional deficiency component, pointing towards this condition.

The name "Subacute Combined Degeneration of the Cord" reflects the degeneration of multiple parts of the spinal cord: the posterior and lateral columns, which fits the symptoms observed in this patient.

Therefore, the most probable diagnosis considering the provided symptoms is Subacute Combined Degeneration of Cord.