Subacute combined degeneration of the cord is caused by vitamin B12 deficiency. The early signs usually include loss of vibration sense and position sense. There is usually a symmetrical peripheral neuropathy, which is associated with absence of ankle reflexes. The sensory ataxia leads to a positive Rhomberg's sign. Knee reflexes are often brisk and plantars are extensor due to pyramidal involvement causing upper motor signs.
Vitamin B12 deficiency may also cause optic atrophy and confusion.
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