How would you cure a pati...

A 50-year-old woman has abdominal pain. Small bowel obstruction was doubted, and conservative treatment was performed. However, she did not improve for two weeks, so she underwent the surgical treatment of adhesion-lysis and a small intestinal suture. Following the operation, she was in a state of reduced consciousness and continued to have a fever. She was treated in an ICU. Her consciousness level recovered to alert in a week, but other symptoms such as ataxia, limb weakness, and dysarthria gradually developed over several weeks. She had spent nearly six weeks in a bed-ridden state without improving. 

A physical examination revealed that the muscle strengths of bilateral lower extremities were 2/5 in both proximal and distal muscles. In addition, bilateral limb and truncal ataxia were observed, as shown in the figure. The electrophysiologic test showed sensorimotor peripheral polyneuropathy, mainly in the lower extremities. The whole spine MRI showed standard T1 and abnormal high T2 signal in the spinal cord's bilateral posterior and lateral horn at the C5 level. All laboratory values were average except Serum vitamin E levels. Finally, it was diagnosed as subacute combined degeneration associated with vitamin E deficiency. However, after six weeks of vitamin E supplementation, her functional level improved substantially.