Complaint : 36Y,
Male bilateral lower limb weakness, tingling & parasthesia from 6 months. No H/O Trauma.
MRI Mid cervical spine, T2 Wt. Images of Axial sections.
MRI : Abnormal T2 hyper intensity confined
to dorsal columns with an inverted 'V' configuration or inverted rabbit
Vitamin B12 deficiency / sub acute combined degeneration of the
T2 hyper intense confined to
dorsal columns highly suggestive of Vitamin B12 deficiency.
Confirmation with laboratory
data decreased plasma B12 levels.
Differential Diagnosis :
Spinal cord infarction
presentation, motor > sensory symptoms
ventral cord or central gray matter signal changes
Spinal cord contusion
T2 hyperintensity +/- hemorrhage
fracture, soft tissue injury
clinical findings enable diagnosis
sclerosis or acute disseminated encephalomyelitis (ADEM)
focal, patchy than B12 deficiency, do not show specificity for
lateral or dorsal columns
myelopathy, Varicella-Zoster/Herpes, Lyme disease
findings may be identical to B12 deficiency
laboratory findings help distinguish
Acute transverse myelitis
(non-traumatic) presentation => diffuse multisegmental cord
known etiology; clinical and laboratory findings may help
protein, pleocytosis, +/- oligoclonal bands (28%)
Special features to
symptoms appear first with motor (spastic paraparesis, gait
and sensory (paraesthesias,
absent reflexes, loss of joint position sense and vibration sense).
arrests degenerative process but does not restore destroyed neural
may not completely resolve.
anesthesia in vulnerable patients.
REFERENCE : Ross, Brant-Zawadzki.Moore, Diagnostic Imaging,
Spine 1st edition, 2004.
Academic division, 'MA' Advanced Diagnostic & Research Centre, Guntur, AP. INDIA.
DR. M.ADINARAYANA RAO. MD.
DR. G.GOWRI SEKHAR . DNB.,DMRD.
DR. D. PRASAD REDDY. DMRD.