Teaching File Series

Last Next

M R I - Division

Click on the images to view them closely



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 ears

DIAGNOSIS:  Vitamin B12 deficiency / sub acute combined degeneration of the cord.


   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

  • Hyperacute presentation, motor > sensory symptoms
  • Predominantly ventral cord or central gray matter signal changes

   Spinal cord contusion

  • Cord swelling, T2 hyperintensity +/- hemorrhage
  • Associated fracture, soft tissue injury
  • History, clinical findings enable diagnosis

  Inflammatory demyelination

  • Multiple sclerosis or acute disseminated encephalomyelitis (ADEM)
  • Lesions more focal, patchy than B12 deficiency, do not show specificity for lateral or dorsal columns
  • Characteristic clinical presentation

   Infectious myelitis

  • HIV vacuolar myelopathy, Varicella-Zoster/Herpes, Lyme disease
  • Imaging findings may be identical to B12 deficiency
  • Clinical, laboratory findings help distinguish

   Acute transverse myelitis

  • Acute (non-traumatic) presentation => diffuse multisegmental cord hyperintensity, swelling
  • Idiopathic or known etiology; clinical and laboratory findings may help distinguish cause
  • Increased CSF protein, pleocytosis, +/- oligoclonal bands (28%)

Special features to remember

  • Spinal cord symptoms appear first with motor  (spastic paraparesis, gait unsteadiness) .
  • and sensory (paraesthesias, absent reflexes, loss of joint position sense and vibration sense).
  • Treatment arrests degenerative process but does not restore destroyed neural fibers.
  • Imaging changes may not completely resolve.
  • Avoid N2O anesthesia in vulnerable patients.
  • Common in strict Vegetarians


REFERENCE : Ross, Brant-Zawadzki.Moore,  Diagnostic Imaging, Spine 1st edition, 2004.

SUBMITTED BY:  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.



2000 Radiologyworld.com