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Case Report
Subacute combined degeneration: When neuroimaging complements the clinic—A case report
1 Medical student at Iguaçu University, UNIG/RJ, Nova Iguaçu - RJ, Brazil
2 Professor of Neurology - Universidade Iguaçu - UNIG-RJ, Nova Iguaçu - RJ; Physician of the Neurology Service of Nova Iguaçu General Hospital, Nova Iguaçu, RJ, Brazil
3 Professor of Neurology at the University of Iguaçu and Physician at the General Hospital of Nova Iguaçu, RJ, Brazil
4 Physician, Neurologist, Adjunct Professor of Medicine at Universidade Iguaçu - UNIG/Nova Iguaçu, RJ, Brazil
5 Department of Neurology of Hospital Geral de Nova Iguaçu, PhD student in Neurology at the Federal University of the State of Rio de Janeiro - UNIRIO, Adjunct Professor of Medicine at Iguaçu University - UNIG/Nova Iguaçu, RJ, Brazil
Address correspondence to:
Antonio Marcos da Silva Catharino
Rua Gavião Peixoto 70, Room 811, CEP 24.2230-100, Icaraí, Niterói-RJ,
Brazil
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Article ID: 101423Z01DP2023
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Pereira DA, Rodrigues ASP, Gilberto CM Jr, Silveira VC, Neves MAO, da Silva Catharino AM. Subacute combined degeneration: When neuroimaging complements the clinic—A case report. Int J Case Rep Images 2023;14(2):118–122.ABSTRACT
Introduction: Low serum B vitamin levels are potentially causally related to these prevalent mental symptoms. Because of this, cobalamin—vitamin B12—is crucial for producing myelin and neurotransmitters. Additionally, subacute combined degeneration (SCD) is one of the consequences of B12 deficiency. Symptomatology often is paraplegia, spasticity, and contractures which are typically progressive. In addition, as the disease advances, they experience a distal sensorimotor loss that ascends proximally and causes spastic quadriparesis and generalized hypoesthesia.
Case Report: Male, 33 years old, with a history of a fall in December 2015, when pain and discomfort started in the left lower limb. A year ago, she evolved with paraparesis, loss of sphincter control, sensory changes in the extremities of the limbs and sensory level at T10, in addition to a report of visual disturbance in the left eye. At that time, the dosage of vitamin B12 was very low—50 pg/mL (reference above 300 pg/mL). On physical examination: extrapyramidal syndrome with hypoesthesia at the distal level. Bilateral Hoffmann’s sign, spastic paraparesis, hyperreflexia in the lower limbs, clonus in the feet, and loss of sphincter control. Sensitive level at T10. Magnetic resonance imaging (MRI) showed cervical dorsal lumbar spinal cord and cone with hypersignal focus on the lateral and posterior cords and skull hypersignal focus in the topography of the corticospinal tracts, suggestive of combined subacute degeneration.
Conclusion: Vitamin B12 deficiency, in addition to other pathologies, is also found in SCD. When treated early, these alterations found in the imaging exam can be resolved without signs of atrophy. Thus, neuroimaging plays a relevant role in the diagnosis, complementing the clinic.
Keywords: Subacute combined degeneration, Spinal cord degeneration, Vitamin B12 deficiency
SUPPORTING INFORMATION
Author Contributions
Daniel Antunes Pereira - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Angélica Sabino Pereira Rodrigues - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Gilberto Canedo M Jr - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Valéria Camargo Silveira - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Marco Antônio Orsini Neves - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Antonio Marcos da Silva Catharino - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Daniel Antunes Pereira et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
