Subacute combined degeneration

Excerpt

A 67-year-old white male was admitted to our Department to investigate a 3-week history of distal numbness in all four limbs. Previous clinical history was unremarkable. Neurological examination revealed only slight hypoesthesia and hypopallesthesia with stocking-and-glove distribution. Nerve conduction studies were normal in all the four limbs. Laboratory studies showed macrocytic anaemia (red cell count 2.39 × 10¹²/l, haemoglobin level 8.9 g/dl, mean corpuscular volume 121.1 fl, mean corpuscular haemoglobin 42.6 pg/ml). The blood vitamin B12 concentration was 35 pg/ml (normal value 158–600). Gastroscopy revealed an atrophic gastritis. Magnetic resonance imaging (MRI) revealed a symmetric hyperintensity of the dorsal columns of the cervical cord at the C5–C7 level. (Fig. 1a, b) The patient was treated with intramuscular injection of mecobalamin (500 μg) with prompt recovery.

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