A 38 years old female patient presented with gradually worsening unsteady gait as well as numbness and tingling in hands and feet. At the time of admission neurological examination revealed slight weakness of distal muscles, bilaterally absent ankle jerk reflexes, bilaterally extensor plantar reflexes, and loss of position and vibration senses in all extremities. Brain MRI was unremarkable. T2 weighted MRI of the cervical spinal cord showed high signal lesions in the posterior columns extending to the upper thoracic spinal cord . This finding is caused due to deficiency of?
High-Yield Explanation
Above findings are suggestive of sub-acute degeneration of spinal cord. It is most commonly caused due to vitamin B-12 deficiency. Dorsal column of spinal cord is affected more frequently which result in paresthesias, diminished proprioception and vibration sensation, motor weakness, clonus or hyperreflexia, areflexia, autonomic dysfunction, gait disturbance, intellectual or behavioral impairment, and impaired visual acuity. MR findings include T2 hyperintensity involving the dorsal column of spinal cord and give rise to 'inveed V sign'.