A 42-year-old man from rural India presented with asymmetric progressive paraparesis mimicking compressive dorsal myelopathy, followed by distal upper limb, truncal and neck-flexor weakness, further complicated by acute urinary retention. His sensory deficits were marked by loss of joint position sense (JPS) and graded loss of vibration sense, along with a definite sensory level. Deep tendon jerks were hypo-to-areflexic, plantar was bilaterally extensor. He had become less attentive and occasionally failed to keep track with conversations. A syndromic diagnosis of myeloradiculoneuropathy with cognitive impairments was made. Further tailored investigations revealed vitamin B12 deficiency with positive anti-parietal cell antibody. Diagnosis of subacute combined cord degeneration (SACD) was confirmed. Neuro-imaging revealed intramedullary intensity changes only along lateral aspect of spinal cord instead of characteristic posterior involvement. Following parenteral vitamin B12 supplementation, patient started showing improvement in motor power and subjective sensory symptoms. His bladder symptoms persisted initially, however recovered finally after 6 months.
- spinal cord
- pernicious anemia
- vitamins and supplements
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Contributors ShD contributed to conception, literature review and initial drafting of manuscript, carrying out all the necessary investigations, collecting all the relevant data and was directly involved in patient care. SoD was involved in supervision of patient’s management, gave expert opinion regarding the case and contributed to editing, critical revision and final approval of the manuscript. He also supervised the entire attempt to report the case. AP gave expert opinion regarding the case, and was involved in critical revision and final approval of the manuscript. BKR contributed to supervision of patient’s management, gave expert opinion regarding the case and contributed to critical revision and final approval of the manuscript. All the authors are in agreement to be accountable for all the aspects of the work in ensuring that query related to its authenticity and accuracy are adequately evaluated and settled.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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