Vitamin B12 Deficiency Resulting in Subacute Combined Degeneration in the Spinal Cord and a Typical Magnetic Resonance Image

Abstract

A 78-year-old woman presented with slowly progressive weakness of her hands and numbness in her feet when she stood up or walked. A neurological examination showed generally brisk deep tendon reflexes. Her ability to feel vibrations was reduced, particularly in her lower limbs. She is not a vegetarian and has no history of gastric surgery. Laboratory blood analyses disclosed macrocytic anemia (Hemoglobin [Hb]: 6.4 g/dl; mean corpuscular volume [MCV]: 137 fl), and low serum vitamin B12 (110 pg/ml). After a blood transfusion, her Hb rose to 11 g/dl and her MCV to 112.5 fl. A sagittal cervical spinal magnetic resonance image (MRI) reveals a linear high-intensity T2-weighted lesion in the posterior cord from the C2 to the C5 level (Figure 1: left side, arrows). An axial view shows a high signal intensity T2-weighted linear lesion with an inverted V shape in the posterior column (Figure: right side, arrowheads).