Subacute combined degeneration of the spinal cord in a vegan.

SUBACUTE combined degeneration of the spinal cord in nutritional vitamin B12 deficiency states, though a rare complication, has been reported several times (Badenoch, 1954; Wokes, 1956; Smith, 1962; Connor & Pirola, 1963; Riley, 1966; Verjaal & Timmermans, 1967), and its association with veganism (vegans are people who exclude all forms of animal products from their diet) has been duly stressed by Wokes (1956) and Smith (1962). Although vegans would appear to be highly vulnerable subjects for deficiency disease, in fact the incidence of manifest symptoms and signs due to vitamin B12 deficiency is rare, even when the serum levels are well below the range found in pernicious anaemia (Smith, 1962). The reason for this anomaly is not clear, though Smith (1962) advanced the view that tobacco smoking in vitamin B12 deficiency states plays a definite role in the genesis of neurological complications, and ofhis reported cases, the only two patients with subacute combined degeneration of the spinal cord were smokers. We consider our patient unique in the sense that she was a vegan who was a non-smoker but nevertheless she developed subacute combined degeneration of the spinal cord.