The Clinical, Demographical and Radiological Characteristics of Eight Patients who Have Spinal Imaging Findings and the Diagnosis of Subacute Combined Degeneration

Abstract

Scientific Backgrounds: The different neurologic manifestations of vitamin B12 deficiency are the results of its effects on the brain, optic nerves, peripheral nerves and spinal cord. Subacute combined degeneration (SCD) of the spinal cord is a complication of vitamin B12 deficiency, which is reversible if diagnosed and treated early. We report eight cases of SCD whose magnetic resonance imaging (MRI) of the spinal cord showed changes in the posterior and lateral columns, correlating well with patients clinical symptoms. Patients and Methods: The clinical, demographical and radiological characteristics of eight patients who had pathological imaging findings in spinal MRI with the diagnosis of SCD and assessed by the clinic of multiple sclerosis for the differential diagnosis of demyelinating disease were determined. Results: Patients who diagnosed SCD, 5 were male and 3 were female. In spinal imagings, was suggestive that the radiological appearance of servical region myelitis in seven case and thoracic region myelitis in one case. Cerebrospinal fluid (CSF) examination was performed and it was normal in all patients. Brain MRI of all patients were normal. In all patients, serum vitamin B12 level was lower than 150 pg/ml and nobody had anemia in hematological examination. Nearly full recovery was seen in six patients who have subacute onset and treated with vitamin B12 replacement in the first six months of therapy and also partial recovery was seen in two patients who have a history of chronic course, with in one year after the treatment. Comments: Some patients who show neurological symptoms and signs may not have megaloblastic anemia which is the major hemotological complication of vitamin B12 deficiency. The most significant sign of the disease may be seen in spinal MRI where posterior columns of the cord show signal changes in T2 weigheted series. However, MRI features are not specific for SCD. The other differential diagnosis with clinical and laboratory features need to be done in patients.