Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature

Abstract

Introduction: Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency. Subacute combined degeneration without anemia or macrocytosis is rare.

Case presentation: We present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B12 supplements and showed improvement in her clinical symptoms.

Conclusion: Physicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.

Figure 1

Transverse T2-weighted magnetic resonance imaging (MRI) scan of the posterior cerebral fossa showing symmetric signal intensity within the medulla oblongata before treatment.

Figure 2

Transverse T2-weighted MRI scan of the cervical spinal cord at the C2 level demonstrating bilateral symmetric signal intensity within the dorsal columns (inverted V sign) before treatment.

Figure 3

Transverse T2-weighted MRI scan of the cervical spinal cord at the C7 level demonstrating symmetric signal intensity within the lateral and dorsal columns before treatment.

Figure 4

Sagittal T2-weighted MRI scan showing the dorsal spinal cord with hyperintensity involving the posterior and lateral columns before treatment.

Figure 5

Sagittal T2-weighted MRI scan showing an area of hyperintensity involving the bilateral posterior and lateral columns of the thoracic and lumbar junction before treatment.

Figure 6

Transverse T2-weighted MRI scan of the cervical spinal cord at the C7 level with normal signal intensity of the lateral and dorsal columns after treatment.