Lichtheims disease

Lichtheims disease

Description, Causes and Risk Factors:

Alternative Name: Subacute combined degeneration of the spinal cord.

Lichtheim's disease is also known as subacute combined degeneration of the spinal cord (posterior and lateral columns of the spinal cord). It occurs when there is damage to the insulating myelin layer, which surrounds nerve fibers, often occurring in the spinal cord. It usually occurs in the spinal cord, but can sometimes affect the brain, eye and other places in the body touched by nerves.

Lichtheim's disease might occur due to a severe lack of vitamin B12. How a lack of vitamin B12 damages nerves is unclear. However, experts believe the lack of this vitamin causes abnormal fatty acids to form around cells and nerves. Some people who have severe vitamin deficiencies might have one of several diseases occurring from lack of nutrients, of which Lichtheim's might be one.

People with Crohn's disease, diabetes or any condition where the body can't absorb vitamins efficiently are at higher risk of getting Lichtheim's.

The Lichtheim's disease may rarely develop as the complication of nitrous oxide (N2O) anesthesia.


lichtheims disease

Specific symptoms may include:

  • Weakness of the legs, arms, middle of the body, or other areas.
  • Tingling and numbness sensation.

Other symptoms may include:

Clumsiness, stiff, or awkward movements.

  • Unsteady gait and loss of balance.
  • Change in mental states such as memory problems, irritability, apathy, confusion, or dementia.
  • Decreased vision.
  • Depression.
  • Sleepiness.
  • Speech impairment.


The health care provider will perform a complete physical exam. An exam usually shows muscle weakness and sensation disturbances on both sides of the body, especially in the legs and arms. Reflexes are often abnormal. Muscles may develop spasticity. You may have a reduced sense of touch, pain, and temperature.

Mental changes range from mild forgetfulness to severe dementia or psychosis. Severe dementia is uncommon, but in some cases, it is the first symptom of the disorder.

Eye Examination: An eye exam may show damage to the optic nerve, a condition called optic neuritis. Signs of nerve inflammation may be seen during a retinal exam. There may also be abnormal pupil responses, decreased visual acuity, and other changes.

The diagnosis of vitamin B12 deficiency is confirmed by a low serum B12 level or elevation of its metabolites(homocysteine and methylmalonic acid).


Early diagnosis of Lichtheim's disease is important because the condition is curable with prompt replacement therapy. The degree of resolution of clinical symptoms is inversely proportional to the duration and severity of vitamin B12deficiency.

The pharmacological treatment often requires B12 shots and continual vitamin injections until the deficiency is fixed. The shots are injected into the muscle, and they may be given once a day. The treatment usually lasts for a week. After that, a patient might be prescribed weekly injections for a month, and then reoccurring monthly. This is a lifetime treatment in order to prevent symptoms from reappearing again.

NOTE: The above information is for the educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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