RATIONALE: There have been a few reported cases of subacute combined 
degeneration (SCD) associated with vitamin E deficiency, but the period of 
intestinal malabsorption was more than several years. We present a rare case of 
acute onset SCD that occurred in a relatively short period of several weeks with 
vitamin E deficiency related to small bowel obstruction.
PATIENT CONCERNS: A 50-year-old woman had abdominal pain. A small bowel 
obstruction was suspected and conservative treatment was performed. She 
underwent bowel surgery after 2 weeks without any improvement. Following the 
operation, she was in a state of reduced consciousness. She was treated in an 
intensive care unit. Her consciousness level gradually recovered to alert in a 
week, but other symptoms such as ataxia, weakness on limbs, severe dysarthria, 
and dysphagia occurred. Since then, she had spent nearly 6 weeks in a bed-ridden 
state without improving.
DIAGNOSIS: SCD associated with vitamin E deficiency was confirmed by laboratory 
investigations, electrophysiologic test, and whole spine magnetic resonance 
imaging scans.
INTERVENTIONS: For vitamin E supplementation, she was administered a dose of 
1200 mg/d. Physical therapy was focused on strengthening exercise, balance, and 
walker gait training. Occupational therapy was focused on activities of daily 
living training and dysphagia rehabilitation.
OUTCOMES: After 6 weeks, her muscle strengths and functional level were 
substantially improved. The vitamin E level was recovered to normal range.
LESSONS: This case suggests that if neurological symptoms occur in patients with 
intestinal obstruction, clinicians need to consider a deficiency of 
micronutrients such as vitamin E and vitamin B12. Patients with short clinical 
courses suffer less neurological damage and achieve faster recovery.