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患者男性,30岁起出现左膝疼痛伴步态异常。33岁首次入院时双下肢呈痉挛性瘫痪,伴双下肢伸肌反射增强,Babinski征阳性。CSF正常,梅毒血清学检查阴性。脊髓造影显示颈中段轻度椎管狭窄,EMG未提供失神经证据。予止痛药和氯苯氨丁酸治疗,其步态异常进行性加重。至38岁时上肢亦出现肌张力增强。左下肢振动觉明显减弱。39岁出现四肢痉挛性瘫痪,伴轻度向上凝视麻痹,但括约肌功能存在。脑干听觉诱发电位示左侧Ⅲ—Ⅴ波延迟而右侧正常。视觉诱发电位示右侧正常,左侧不能定性,血清维生素B12浓度降低至96.2Pmol/L(正常148～443Pmol/L)。经替代治疗后血清B12浓度恢复正常
Male patients, 30-year-old left knee pain with abnormal gait. At the age of 33 on the first admission, both lower extremities were spastic paralysis with increased extremity extensor reflex, Babinski sign positive. CSF normal, syphilis serology negative. Myelography showed mild cervical spinal stenosis, EMG did not provide evidence of denervation. To painkillers and chlorpheniramine treatment, the abnormal gait abnormalities. Up to the age of 38, muscle tension also appeared in upper extremities. Vibration left lower limb significantly reduced. 39-year-old limb spastic paralysis, with slight upward paralysis, but the presence of sphincter function. Brainstem auditory evoked potentials showed that the left Ⅲ-Ⅴ wave delay and right normal. Visual evoked potential showed right normal, left can not be qualitative, serum vitamin B12 concentration was reduced to 96.2Pmol / L (normal 148 ~ 443Pmol / L). After replacement therapy serum B12 concentration returned to normal