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MRI in Vitamin B12 Deficiency Myelopathy

Published online by Cambridge University Press:  05 August 2019

Eduardo R. Locatelli ,
Robert Laureno ,
Pamela Ballard  and
Alexander S. Mark
Eduardo R. Locatelli*
Affiliation:
Department of Neurology, Washington, DC Washington Hospital Center, the Department of Neurology, Washington, DC
Robert Laureno
Affiliation:
Department of Neurology, Washington, DC Washington Hospital Center, the Department of Neurology, Washington, DC
Pamela Ballard
Affiliation:
The George Washington University, and the National Rehabilitation Hospital, Washington, DC
Alexander S. Mark
Affiliation:
Department of Radiology, Washington, DC
*
Department of Neurology, The George Washington University Medical Center, 2150 Pennsylvania Avenue, #7-404, Washington, DC 20037, U.S.A.
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Abstract:

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Background:

Little is known about vitamin B12 deficiency myelopathy's magnetic resonance imaging (MRI) manifestations and their relationship to the onset, evolution, and resolution of neurologic signs and symptoms.

Methods:

We present a case and review eleven additional reported cases of subacute combined degeneration of the spinal cord detected by MRI.

Results:

Our patient had increased T2-weighted signal and gadolinium contrast enhancement of the posterior columns in the cervical and thoracic regions and enhancement of the lateral columns in the high cervical region. This is a case with imaging evidence for lateral column lesions. Two prior reports have shown posterior column enhancement. T1-weighted images may show decreased signal in the posterior columns and sometimes demonstrate reversible spinal cord swelling. MRI abnormalities typically improve after vitamin replacement therapy. However, clinical signs may persist despite resolution of imaging abnormalities, and these abnormalities do not always resolve completely. In addition, symptoms may precede the imaging abnormality.

Conclusions:

Vitamin B12 deficiency may produce an increased T2-weighted signal, decreased T1-weighted signal, and contrast enhancement of the posterior and lateral columns of the spinal cord, mainly of the cervical and upper thoracic segments. Because the symptoms may precede any imaging abnormality, it is clear that spinal cord MRI may not be a highly sensitive, early test for subacute combined degeneration.

Résumé:

Résumé:<span class='italic'>Introduction:</span>

On connaît peu de choses sur les manifestations de la déficience en vitamine B12 à l'imagerie par résonance magnétique (RMN) et sur leur relation avec le début, l'évolution et la résolution des signes et des symptômes neurologiques.

<span class='italic'>Méthodes:</span>

Nous présentons un cas de dégénérescence combinée subaiguë de la moelle détecté par RMN et nous revoyons onze autres cas rapportés dans la littérature.

<span class='italic'>Résultats:</span>

Notre patient avait une augmentation du signal T2 à l'examen en séquence pondérée en T2 et une densification par le gadolinium au niveau de la corne latérale de la moelle à la région cervicale haute. Ceci constitue un cas avec observation à la RMN de lésions de la corne latérale. Chez deux autres cas, on rapportait un rehaussement de la corne postérieure de la moelle. Les images pondérées en T1 peuvent montrer un signal diminué dans les cornes postérieures et parfois un gonflement réversible de la moelle épinière. Il est typique de voir les anomalies de la RMN s'améliorer suite au traitement de remplacement vitaminique. Cependant, les signes cliniques peuvent persister en dépit de la résolution des anomalies observées à l'imagerie et ces anomalies ne disparaissent pas toujours complètement. De plus, les symptômes peuvent précéder les anomalies observées à l'imagerie.

<span class='italic'>Conclusions:</span>

La déficience en vitamine B12 peut produire une augmentation du signal pondéré en T2, une diminution du signal pondéré en T1 et un rehaussement du contraste des cornes postérieures et latérales de la moelle, surtout au niveau des segments cervicaux et thoracique supérieurs. Comme les symptômes peuvent précéder les anomalies observées à l'imagerie, il est clair que la RMN de la moelle n'est probablement pas un test hautement sensible pour détecter précocement la dégénérescence combinée subaiguë.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 1 , February 1999 , pp. 60 - 63
Copyright
Copyright © The Canadian Journal of Neurological 1999

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