A clinical case of prolonged funicular myelosis, hidden under the guise of urological pathology

Abstract

A funicular myelosis is a neurometabolic lesion of the posterior and lateral cords of the spinal cord. This multifactorial condition of cyanocobalamin and folate deficiency leads to ineffective hematopoiesis and impaired myelin formation with damage to the nervous system. The presence of B12‑deficiency anemia makes confirmation of subacute combined degeneration of the spinal cord diagnosis much easier. However, the diagnosis of neurological complications of the disease is difficult if pernicious anemia remains unrecognized. According to the location of the foci of demyelination there are three distinguished clinical forms of funicular myelosis: posterior columnar, pyramidal and combined, depending on the predominant lesion of the lateral or posterior cords. The prognosis for the restoration of lost functions depends on the duration of the disease and the prevalence of changes in the spinal cord. So, the awareness of neurologists about funicular myelosis contributes to early diagnosis and timely adequate treatment. A clinical case of a 72‑year‑old patient admitted to the surgical department with complaints of prolonged urinary retention who was preliminary diagnosed with of Cr. prostatae. The patient was also experienced lower extremities weakness, wasting of the calf muscles, inability to walk, numbness of the toes, fatigue, but the patient did not pay attention to these symptoms. Due to the presence of hypochromic macrocytic anemia, typical changes in the posterior and lateral cords at all levels of spinal MRI, progressive ascending sensory‑motor symptoms, the patient was diagnosed with severe B12‑deficiency anemia, funicular myelosis. During treatment, the patient’s sensitivity disorders completely regressed and motor function significantly improved — the patient was able to walk independently, urination resumed.