A 47-year-old man presented with paresthesia of the arms, disorientation and ataxia. Past medical history included alcoholism, and cholecystectomy one week prior (nitrous oxide was administrated during anesthesia). Neuroimaging revealed bilateral symmetric high signal within the dorsal columns of the cervical cord, suggesting the diagnosis of subacute combined degeneration. On cross-section images, this appearance has been described as the “inverted V sign” ([Figure A], [B]). The laboratory test showed a low serum vitamin B12 level, confirming the diagnosis. Once the deficiency was corrected, the patient improved clinically and the spinal cord signal changes had subsided by the three-month follow-up ([Figure C], [D])[1],[2],[3].
Figure Neuroimaging findings in subacute combined degeneration. Sagittal and axial MR spinal images on T2-weighted sequences demonstrate abnormal high signal within the dorsal columns of the cervical cord (A, B), and the complete resolution of signal abnormalities at a three-month follow-up (C, D).
