Abstract
A THIRTY-FIVE-YEAR-OLD woman presented with a 3-month history of progressive dysesthesia of her feet, unsteadiness in the gait, and generalized weakness. There was no history of any surgery or drug intake. On examination, there was moderate pallor. Fine touch, position, and vibration sense were impaired below the anterior superior iliac spines. Romberg's sign was positive. There was mildly reduced motor power (4/5) in both lower limbs. Deep tendon reflexes of lower limbs were exaggerated. Plantars were equivocal. Laboratory tests revealed macrocytic anemia with hemoglobin of 8.6 g/dL, elevated mean corpuscular volume (117 fl), hypersegmented neutrophils, low serum cobalamin (<100 pg/mL), and elevated serum folate levels (22 ng/mL). Magnetic resonance imaging (MRI) of the spine was performed. Figure 1 is a sagittal T2-weighted fast spin-echo (FSE) image showing an abnormal increased signal intensity of the dorsal and lower cervical spinal cord. Figure 2 is an axial T2weighted FSE image at the upper dorsal region showing that the signal abnormality is located in the posterior columns of the spinal cord. Barium meal gastrointestinal series was normal.
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