Inverted V sign in Subacute combined degeneration of spinal cord

Ashok, Kumar; Singh, A. K.
November 2008
Annals of Indian Academy of Neurology;Nov2008 Supplement, Vol. 11, pS184
Academic Journal
A 60-year-old man presented with 3 months history of insidious onset gradually progressive numbness in the tips of fingers leading to difficulty in catching object, buttoning and unbuttoning. He also describes burning pain in soles and toes. On flexion of neck he gets current like paresthesia in hands. Dietary habits was pure vegetarian. Physical examination shows pallor, blackening of knuckles of joints. Neurological examination shows pseudoathetosis in upper limbs, loss of joint position and vibration in toes & fingers, deep tendon reflexes were brisk with depressed ankle jerk, right plantar was extensor, gait was wide based & cautious and rhomberg were positive. MRI cervical spine: Sagittal T2-weighted image of the cervical spinal cord shows hyperintensity in the dorsal aspect of the cord extending from the level of C1 to the level of superior end plate of C4. STIR coronal image of the cervical spinal cord of the same patient shows linear hyperintensity corresponding to the T2 Sagittal abnormality. Transverse T2-weighted MR image obtained through the cervical spinal cord at C2 level demonstrates bilateral symmetric signal intensity abnormality within the dorsal columns (Inverted 'V' sign). Haematological test shows macrocytic, hypochromic anemia with pancytopenia, hypersegmented neutrophils. Mean corpuscular volume was high. Serum B12 concentration was low at 90ng/l. Intrinsic factor antibody was negative. Gastric biopsy shows normal mucosa. Patient was diagnosed as a case of Subacute combined degeneration of spinal cord due to vitamin B12 deficiency as a result of inadequate intake.


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