Spinal MRI supporting myelopathic origin of early symptoms in unsuspected cobalamin deficiency.
We report two patients with subjectively progressive sensory symptoms and gait disturbance due to cobalamin deficiency, but only slight or absent abnormalities on neurological examination. In both patients, spinal MRI provided evidence for a myelopathic origin of the symptoms, disclosing characteristic T(2) hyperintense signal alterations confined to the posterior columns of the cervical and thoracic spinal cord. The patients illustrate the early clinical presentation of subacute combined degeneration (SCD) with a sensory neuropathy starting with acroparesthesia and Lhermitte's sign. Furthermore, the diagnostic value of spinal MRI for early diagnosis of SCD with characteristic findings is highlighted.
Fritschi
Jürg
J
Department of Neurology, University of Bern, Bern, Switzerland. juerg.fritschi@insel.ch
Sturzenegger
Matthias
M
D000328:Adult; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration / Q000175:diagnosis* / Q000209:etiology*; D012678:Sensation Disorders / Q000209:etiology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000209:etiology*; D014806:Vitamin B 12 Deficiency / Q000150:complications*