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Subacute combined degeneration of the spinal cord in vitamin B12 and copper deficiency
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  1. Rainer Schimana,
  2. Heinz Ober,
  3. Oliver Neuhaus
  1. Department of Neurology, SRH Kliniken Landkreis Sigmaringen GmbH, Sigmaringen, Germany
  1. Correspondence to Dr Oliver Neuhaus, o.neuhaus{at}klksig.de

https://doi.org/10.1136/bcr-2017-222446

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    Description

    A 67-year-old man with a medical history of pancreatoduodenectomy (Whipple procedure) in September 2015 due to a pancreatic cancer was admitted to our department of neurology 1 year later with a progressively disturbed gait. He reported weakness and numbness of both legs. Clinical examination revealed a spastic sensomotoric tetraparesis with ataxia and bladder dysfunction. MRI showed longitudinal myelopathy exactly limited to the posterior tracts (fasciculus gracilis and fasciculus cuneatus) indicating a metabolic origin (subacute combined degeneration of the spinal cord; figure 1A,B).

    Figure 1

    (A) Axial T2-weighted and (B) sagittal short T1 inversion recovery (STIR) MRI of the cervical spine showing longitudinal myelopathy exactly limited to the posterior tracts (fasciculus gracilis and fasciculus cuneatus, arrows). …

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