Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature

Samira Rabhi,Siham Tizniti,Rhizlane Berrady,Faouzy Belahsen,Hajar Khibri,Mustapha Maaroufi,Wafaa Bono

doi:10.1186/1752-1947-5-166

Abstract

IntroductionSubacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency. Subacute combined degeneration without anemia or macrocytosis is rare.Case presentationWe present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B12 supplements and showed improvement in her clinical symptoms.ConclusionPhysicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.

Highlights

Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency
We present the magnetic resonance imaging (MRI) scans of a patient with Subacute combined degeneration (SCD) involving the lateral and posterior columns extended to segments of spinal cord and without anemia or macrocytosis
We describe new MRI findings of the spinal cord in SCD revealing vitamin B12 deficiency without anemia and or macrocytosis

Summary

Introduction

Vitamin B12 deficiency usually presents with various hematological, gastrointestinal and neuropsychiatric manifestations. Background and history did not reveal preexisting diabetes mellitus, alcohol addiction, vegetarian food preference or gastrointestinal symptoms She did not mention any fever, night sweats or itching. The initial MRI examination of the cervical and dorsal spine was performed using a 1.5-T unit and showed an area of hyperintensity involving the dorsal and lateral columns from the medulla oblongata (Figure 1) to the thoracic spine (Figure 2, Figure 3 and Figure 4) on T2weighted images. This area was not enhanced after the addition of gadolinium.

Discussion

Findings

Conclusion

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