Age / Sex : 59 / M

Subacute combined degeneration (SCD)

Discussion

Findings:

MRI :

Sagittal T2WI MR image of the cervical spine shows a long segmental high signal intensity, involving upper cervical spine (extending from C1 through C5).

On axial T2WI, this lesion reveals bilateral symmetric high signal intensity in the posterior columns of the cervical spine. 

Differential Diagnosis:

1. Multiple sclerosis


2. Neuromyelitis optica


3. Acute idiopathic transverse myelitis


4. Acute disseminated encephalomyelitis (ADEM)


5. Acute spinal cord infarction 

Diagnosis: 

Subacute combined degeneration (SCD) 

Discussion:

Subacute combined degeneration (SCD)  –

-  Potentially reversible myelopathy and neurological complication of vitamin B 12 (Cobalamin) deficiency, associated with pernicious anemia.

-   Demyelination and axonal loss in the posterior and lateral columns (cervical and thoracic

spinal cord).

-    Acquired Copper deficiency and Nitrous Oxide toxicity ; identical clinical and MRI findings

-   The MRI findings - long-segmental, bilateral symmetric T2-hyperintensity of the posterior columns described as an “inverted V” or “rabbit-ear” appearance, without contrast enhancement.

-    Imaging improvement correlates with clinical improvement. 

References:

1. Kiers L, Desmond P. Magnetic resonance imaging in subacute combined degeneration of the spinal cord. J Clin Neurosci. 1999 Jan;6(1):49-50.


2. Ferrara JM, Skeen MB, Edwards NJ, Gray L, Massey EW. Subacute combined degeneration due to copper deficiency. J Neuroimaging. 2007 Oct;17(4):375-7.


3. Sun HY, Lee JW, Park KS, Wi JY, Kang HS. Spine MR imaging features of subacute combined degeneration patients. Eur Spine J. 2014 May;23(5):1052-8.