Presentation
The patient was suspected to have prostate cancer because of urinary retention. Additional symptoms included progressing weakness in low extremities, weight loss of calf muscles, sensitive ataxia, toes hypoalgesia, and fatigue. Eventually, hypoalgesia expanded to knee level. The original diagnosis was low extremities polyneuropathy with impairment of reflective and neurotrophic function. Treated with anticholinergic medications with no effect.
Patient Data
MR images show hyperintensities in posterior and lateral columns of cervical, thoracic and lumbar spinal cord on T2 sequences.
Case Discussion
Based on the history and neurological examination data a wide differential diagnosis of Guillain–Barré syndrome, acute inflammatory demyelinating polyneuropathy, distal mononeuropathy, paraneoplastic polyneuropathy, systemic vasculitis with periphery nervous system damage, and inherited polyneuropathy as considered.
Retrospective analysis of the patient's data demonstrated anemia (hemoglobin 109 g/l) and atrophic gastritis. He was also B12 deficient (56,94 pg/ml).
Considering quite specific MRI changes the final diagnosis was subacute combined degeneration of the cord due to severe B12 deficiency.
This case shows the importance of suspicion of this entity in patients with B12-anemia, polyneuropathy-like manifestations, weight loss and atrophic gastritis and the importance of imaging.
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