脊髓亚急性联合变性

Description:

A 55-year-old man with megaloblastic anemia, progressive weakness of lower limbs, gait disturbance, and ataxia

55岁男性，巨幼红细胞性贫血患者。渐进性双下肢无力、步态不稳、共济失调。

图A:

图B：

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Legends:

Sagittal STIR (A) and axial T2WI (B) demonstrate symmetric increased signal (arrows) along the dorsal columns of the spinal cord.

矢状位STIR (A)及横断位T2WI (B) 示脊髓后索对称性高信号。

图A:

图B:

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Subacute Combined Degeneration

脊髓亚急性联合变性

Subacute combined degeneration is an acquired myelopathy caused by vitamin B12 deficiency, and is a rare cause of demyelination of the dorsal columns of the spinal cord.

亚急性联合变性是由于维生素B12缺乏所致的脊髓病变，是脊髓后索脱髓鞘病变的罕见诱因之一。

Clinical Presentation:

Profound neurologic deficits, including progressive sensory abnormalities, ascending paresthesias, weakness, ataxia, loss of sphincter control, and gait impairment. Megaloblastic anemia is a common early symptom leading to the diagnosis; although, neurologic symptoms may occur in the absence of haematologic abnormalities.

严重的神经功能缺陷，包括渐进性的感觉异常、不断加重的皮肤感觉障碍、虚弱、共济失调、大小便失禁（括约肌功能丧失）和步态障碍。巨幼细胞性贫血是常见的早期症状，也有部分患者不伴有血液系统异常。

Key Diagnostic Features:

• Symmetric increased signal seen on T2 and STIR images within the dorsal (and less commonly, lateral) columns: 'inverted V' sign in axial plane.

  T2WI和STIR序列可见脊髓后索（也可发生于脊髓侧索，少见）对称性高信号，横断位可见“倒V征”。

• Mild mass effect and mild contrast enhancement may be present.

  病灶有轻度占位效应。增强扫描轻度强化。

DDx:

• Dorsal column myelopathy 脊髓后索病变

• HIV myelopathy HIV脊髓病

• Nitrous oxide toxicity 一氧化二氮（笑气）中毒

• Copper deficiency 铜缺乏症

• Cyanide toxicity 氰化物中毒

• Spinal cord infarction 脊髓梗死

• Demyelination 脱髓鞘病变

• Other causes of transverse myelitis

  可导致的横贯性脊髓炎的其他原因

Rx:

Vitamin B12 therapy

维生素B12治疗