Acute combined demyelination of the spinal cord often starts insidiously in middle age, with no significant difference between men and women. The disease usually presents as subacute or chronic, progressing gradually. Before the appearance of neurological symptoms, most patients exhibit anemia. Some patients with gastric acid deficiency may have mild or severe anemia, showing symptoms such as fatigue, weakness, palpitations, dizziness, diarrhea, slight glossitis, and edema. In cases accompanied by gastrointestinal diseases, patients may experience decreased appetite, constipation or diarrhea, pale lips, etc.
Neurological symptoms often manifest as symmetrical sensory abnormalities in the fingers and toes, such as tingling, numbness, and burning sensation, which are persistent and more severe in the lower limbs. Sensory abnormalities can extend upwards to the trunk, and objective physical examination of the extremities often shows normal sensory function. A few patients have symmetrical glove or sock-like sensory impairment. Damage to the posterior column of the spinal cord gradually leads to clumsy limb movements, tendency to fall, walking with a sensation of stepping on cotton, difficulty walking with eyes closed or in the dark. Motor disorders usually appear later than sensory disorders, with the lower limbs possibly showing incomplete spastic paraplegia. Physical examination may show weakness in the lower limbs, increased muscle tone, hyperreflexia, and positive pathological signs.
Approximately535% of patients present with optic atrophy and bilateral central scotoma, narrowing of the visual field, decreased vision, or blindness. A few patients may show symptoms such as apathy, drowsiness, irritability, suspicion, depression, and unstable emotions. In severe cases, there may be mental confusion, looking forward, delusion, hallucinations, paranoid-like tendencies, decline in cognitive function, decreased memory, and even dementia.