Subacute combined degeneration of the cord (funicular myelosis)

Case contributed by Dr Andrei Tsoriev


B12-deficiency anemia for 3 months, hemoglobin 74 g/L, anisocytosis, macrocytosis. Bilateral hands numbness. Long history of atrophic gastritis.

Patient Data

Age: 45 years
Gender: Male

MRI of cervical spine

Linear, longitudinal T2-hyperintensity and T1-hypointensity in posterior funiculi of spinal cord, at both sides, symmetric. Low bone marrow signal at both T1 and T2 weighted images, compartible with high cellularity due to anemia. At T1-weighted images bone marrow signal is lower than signal of intervertebral disks (should have the same intensity).

Case Discussion

One of the neurologic features of B12-deficiency anemia is involvement of posterior and lateral columns of the spinal cord (subacute combined degeneration or funicular myelosis).

Begins more often with a sensation of numbness, sometimes cold, tightness in the tips of the toes and in the fingertips, rarely may be severe pain. Involvement of arms and legs at the same time is  not common, onset with legs can be seen more frequent.

Spinal MRI frequently shows longitudinal T2 hypersignal lesion at posterior part of the spinal cord symmetrically distributed, often with sharply demarcated margins.

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Case information

rID: 33703
Published: 21st Jan 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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