Subacute combined degeneration of a spinal cord
Alcoholic male patient with tingling and numbness in upper limb since 2 months.
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The sagittal T2 images show abnormal hyperintensity within the posterior aspect of the cervical cord extending from the level of C4 to C6. Axial T2 images at these levels show symmetric abnormal hyperintensity within the posterior spinal cord corresponding to the dorsal columns. The areas of abnormal T2 hyperintensity within the dorsal columns show post contrast enhancement shown in coronal T1 c+fat sat images. This distinctive pattern of abnormal signal intensity is suggestive of subacute combined degeneration of the spinal cord.
Subacute combined degeneration (SACD) is caused by vitamin B12 deficiency. A serum vitamin B12 test was performed and showed a diminished serum B12 level of 56 pg/mL and this abnormal reading was confirmed with a repeat test, which indicated a B12 level of 51 pg/mL. The normal range of serum B12 is 200–1000 pg/mL.
Histopathogically, there is demyelination of the dorsal columns, predominately in the lower cervical and upper thoracic region. If it is not controlled it can eventually involves the entire dorsal columns, spreading cranial to caudal direction.