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MRI in vitamin B12 deficiency myelopathy
E R Locatelli1, R Laureno, P Ballard
1Department of Neurology, Washington Hospital Center, DC, USA.
Background:
Little is known about vitamin B12 deficiency myelopathy's magnetic resonance imaging (MRI) manifestations and their relationship to the onset, evolution, and resolution of neurologic signs and symptoms.
Methods:
We present a case and review eleven additional reported cases of subacute combined degeneration of the spinal cord detected by MRI.
Results:
Our patient had increased T2-weighted signal and gadolinium contrast enhancement of the posterior columns in the cervical and thoracic regions and enhancement of the lateral columns in the high cervical region. This is a case with imaging evidence for lateral column lesions. Two prior reports have shown posterior column enhancement. T1-weighted images may show decreased signal in the posterior columns and sometimes demonstrate reversible spinal cord swelling. MRI abnormalities typically improve after vitamin replacement therapy. However, clinical signs may persist despite resolution of imaging abnormalities, and these abnormalities do not always resolve completely. In addition, symptoms may precede the imaging abnormality.
Conclusions:
Vitamin B12 deficiency may produce an increased T2-weighted signal, decreased T1-weighted signal, and contrast enhancement of the posterior and lateral columns of the spinal cord, mainly of the cervical and upper thoracic segments. Because the symptoms may precede any imaging abnormality, it is clear that spinal cord MRI may not be a highly sensitive, early test for subacute combined degeneration.
Insights
Vitamin B12 deficiency myelopathy shows characteristic MRI findings in the spinal cord, but symptoms may appear before imaging changes. MRI abnormalities often improve with treatment, though clinical signs may linger.
Area of Science:
- Neurology
- Radiology
- Biochemistry
Background:
- Vitamin B12 deficiency myelopathy, also known as subacute combined degeneration, affects the spinal cord.
- Its magnetic resonance imaging (MRI) manifestations and relationship to clinical progression are not well-understood.
Observation:
- This study reviewed 12 cases of subacute combined degeneration diagnosed by MRI.
- The patient presented with T2-weighted hyperintensity and contrast enhancement in posterior and lateral spinal cord columns.
Findings:
- MRI revealed increased T2-weighted signal, decreased T1-weighted signal, and contrast enhancement in posterior and lateral columns, primarily in cervical and upper thoracic segments.
- Spinal cord swelling may be reversible on T1-weighted images.
- Clinical symptoms can precede MRI abnormalities, and imaging changes may not fully resolve despite treatment.
Implications:
- Spinal cord MRI may not be a sensitive early diagnostic tool for subacute combined degeneration.
- Vitamin B12 replacement therapy can improve MRI findings, but clinical recovery may be incomplete.
- Understanding these MRI patterns aids in diagnosing and managing vitamin B12 deficiency myelopathy.