Subacute combined degeneration of the cord

Case contributed by Vinay V Belaval
Diagnosis certain


Both upper limb numbness since 1 month.

Patient Data

Age: 50 years
Gender: Male

There are symmetrical T2w hyperintense signals in the posterior columns of the cervical cord from C1 to C6 levels with an inverted-V appearance on axial images. No cord expansion is seen. These features are typically seen in subacute combined degeneration of the cervical cord.

Cervical disc desiccation is noted with degenerative disc bulges from C4-5 to C6-7 levels.

Case Discussion

Subacute combined degeneration of the spinal cord refers to demyelination of posterior and lateral columns of the cord, presenting commonly with numbness of extremities. It is commonly seen due to vitamin B12 deficiency and early diagnosis by screening MRI spine can help in initiating the treatment with reversal of myelopathic changes. If the serum B12 levels are near-normal, the levels of methylmalonic acid and homocysteine should be checked for confirmation.

This patient had low serum vitamin B12 levels and was treated with B12 injections.

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