Correlation of Clinical and MRI Features of Neuropsychiatric Manifestations in Sub-acute Combined Degeneration of Spinal Cord: Neurological Syndrome Associated with Vitamin B12 Deficiency

Abstract

Vitamin B12 or cynacobalamin is an important water soluble vitamin which plays a key role in erythropoiesis, proper nervous system functioning and for the metabolism of carbohydrate, fat and protein. Patients with cynacobalamin deficiency may present with haematological, gastro-intestinal, oral, dermatological, psychiatric and neurological disturbances. We present a case of sub-acute combined degeneration (SACD) of spinal cord in a fortynine year old female presenting with one month history of progressive symptoms of lower limb paraesthesia, sensory deficit, psychotic symptoms and postural instability. This case report is unusual as it elucidates the characteristic triad, i.e., haematological, psychiatric and neurological symptoms in sub-acute combined degeneration of spinal cord (SACD) associated with B12 deficiency, correlation of its clinical manifestations, electrophysiological signs, laboratory investigations ( especially biomarkers of B12 status) and spinal magnetic resonance (MR) imaging in establishing the diagnosis, treatment outcomes, and potential therapeutic relevance of vitamin B12 replacement therapy in symptoms remission.