A 75-year-old man, with no history of interest, presented with a two-month history and slowly progressive course that the patient described as «swellings» in the tips of the fingers, but initially affecting both feet.
Neurological examination revealed tactile hypoesthesia with «gunte» and «calcetin» distribution, malleolar apalesthesia and hypopalesthesia in tibial crests and elbows.
Reflexes were present and symmetrical.
The rest of the neurological examination was normal.
The presence of paresthesias, with altered vibratory sensitivity and preservation of reflexes in neurological examination, forces us to consider that the patient suffers a cervical spinal cord injury with involvement of the posterior cord.
Laboratory tests (including vitamin B12 levels), cervical MRI and neurophysiological study were performed.
Cervical MRI (Magnetom-Trio, Siemens, Erlangen, Germany) showed in T2-weighted sequences in the sagittal plane a signal hyperintensity with no mass effect at the cord level C7.
Axial and coronal sections showed bilateral and symmetrical involvement.
These findings are characteristic of DCS.
No signs of polyneuropathy were observed in the study of conduction velocities, while the somatosensory evoked potentials were unstructured and with increased latencies in the four posterior limbs, indicating involvement.
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The complete blood count showed a mild anemia, normal hematocrit 4,44 10E12 hemoglobin (4,7-5,1 10E12/L), MCV: 108 pg/47 and MCH: 159 gL, 34.
Serum vitamin B12 levels were 78 pg/mL (210-930 pg/mL) and folic acid levels were 26.5 ng/mL (2.2-16.9 ng/mL), the rest of the biochemical measurements being normal.
Antibodies against gastric parietal cells were positive (1/40), as well as anti-FI antibodies (intrinsic factor) (>97.9; normal: 0-25).
Gastric biopsy showed signs of chronic gastritis of atrophic aspect, with increased inflammatory infiltrate.
With the diagnosis of CSD, the patient was treated with cyanocobacteria (1,000 μ/day intramuscularly for two weeks and then monthly).
In the following months, the patient presented a progressive improvement of the mental disorders.
At 10 months of evolution, the patient complained of a mild and unconfirmed sensation of «hormygue» in the feet and the neurological examination showed only mild malleolar hypopalesthesia.
Control laboratory tests showed resolution of megaloblastic anemia and vitamin B12 levels (438 pg/mL).
A control spinal MRI scan using the same equipment revealed complete disappearance of the lesions and normal signal intensity of the spinal cord.
