【PHILIPS case per day】Subacute combined degeneration of the spinal cord

Recently, Garcia Ortega and others from Murcia, Spain, published the following teaching case
in AJNR magazine.

A 70-year-old woman with sudden numbness and weakness in her hands and feet and difficulty
walking.

Combined with the above figure, consider how to diagnose?

A.
Acute disseminated encephalomyelitis

B.
Paraneoplastic myelopathy

C.
Neuromyelitis optica

D.
Subacute combined degeneration

Answer: D.
Subacute combined degeneration

Subacute combined degeneration (SCD) is a neurodegenerative disease caused by vitamin B12 deficiency, and its clinical manifestations are mainly deep sensory loss, sensory ataxia, and spastic paralysis in posterior spinal cord and lateral cord damage, often accompanied by peripheral sensory impairment
due to peripheral nerve damage.
If diagnosed and treated early, symptoms can be reversible
.

Vitamin B12 deficiency is often associated with
pernicious anemia, malabsorption syndrome, or inadequate vitamin B12 intake.
Low serum vitamin B12 levels are one of
the conditions for diagnosing SCD.
Typical MRI shows abnormally high intensity of the posterior cord cord that runs through the cervical and thoracic cords on T2 images (red arrows in figures A and B), and mild hyperintensity
is seen on enhanced T1 images.

The following statements about subacute combined degeneration of the spinal cord are erroneous: