Subacute combined degeneration of the cord (funicular myelosis)
B12-deficiency anemia for 3 months, hemoglobin 74 g/L, anisocytosis, macrocytosis. Bilateral hands numbness. Long history of atrophic gastritis.
MRI of cervical spine
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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).
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.