Báo cáo y học: Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature...
Nội dung trích xuất từ tài liệu:
Báo cáo y học: "Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature"Rabhi et al. Journal of Medical Case Reports 2011, 5:166 JOURNAL OF MEDICALhttp://www.jmedicalcasereports.com/content/5/1/166 CASE REPORTS CASE REPORT Open AccessMagnetic resonance imaging findings within theposterior and lateral columns of the spinal cordextended from the medulla oblongata to thethoracic spine in a woman with subacutecombined degeneration without hematologicdisorders: a case report and review of theliteratureSamira Rabhi1*, Mustapha Maaroufi2, Hajar Khibri1, Faouzy Belahsen3, Siham Tizniti2, Rhizlane Berrady1 andWafaa Bono1 Abstract Introduction: Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B12 deficiency. Subacute combined degeneration without anemia or macrocytosis is rare. Case presentation: We present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B12 supplements and showed improvement in her clinical symptoms. Conclusion: Physicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.Introduction leading to the diagnosis of vitamin B12 deficiency, neu-Vitamin B 12 deficiency usually presents with various rological symptoms have often been considered to behematological, gastrointestinal and neuropsychiatric late manifestations and typically occur after the develop-manifestations. Commonly seen neuropsychiatric mani- ment of anemia [2]. We present the magnetic resonancefestations include myelopathy, neuropathy, dementia, imaging (MRI) scans of a patient with SCD involvingneuropsychiatric abnormalities and, rarely, optic nerve the lateral and posterior columns extended to segmentsatrophy. Subacute combined degeneration (SCD) of the of spinal cord and without anemia or macrocytosis.spinal cord is an uncommon cause of myelopathy but is Case presentationthe most frequent clinical manifestation of vitamin B12deficiency [1]. As anemia is a common early symptom A 29-year-old Moroccan woman came to our institution complaining of numbness and tingling of four months’ duration in both lower limbs, with unsteady gait and* Correspondence: rabhisamira@gmail.com easy falling and urine incontinence. The patient ’ s1 Department of Internal Medicine, Hassan II University Hospital, Fez, MoroccoFull list of author information is available at the end of the article © 2011 Rabhi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Rabhi et al. Journal of Medical Case Reports 2011, 5:166 Page 2 of 4http://www.jmedicalcasereports.com/content/5/1/166background and history did not reveal preexisting dia-betes mellitus, alcohol addiction, vegetarian food prefer-ence or gastrointestinal symptoms. She did not mentionany fever, night sweats or itching. On physical examina-tion, her temperature was 37.4°C, her pulse was 80beats/minute and her blood pressure was 120/83mmHg. She had no pallor or icterus and no lymphade-nopathy, edema, splenomegaly or hepatomegaly. Onneurological examination, her deep tendon reflexes werehyperactive in the upper and lower extremities. Babins-ki’s sign, Romberg’s sign and Lhermitte’s sign were pre-sent. Vibration and joint position sense examinationwere evaluated as decreased. However, there was nodecrease in light touch sensation. Her laboratory exami-nation values were unremarkable: white blood cell count8,500/mm 3 , hemoglobin 13 g/dL, mean corpuscularvolume 97/μ3, platelets 225,000/mm3 and thyroid-stimu- Figure 2 Transverse T2-weighted MRI scan of the cervical ...