Subacute Combined Degeneration Of The Cord: Lateral Column Involvement Seen On Mri –An Uncommon Finding

A 46 year old man, a vegetarian, presented with acute onset of paresthesia (“pins and needles” sensation) involving both hands and feet of 15 days duration. He also complained of difficulty in walking and inability to feel the ground for the same period. There was no history of trauma, fever, vomiting, diarrhea, upper respiratory tract infection, visual disturbances, and bladder or bowel incontinence. On examination, the patient was restless and agitated but his higher mental functions were normal. There was impairment of sensation of fine touch, pin prick, joint position and vibration in both hands and feet bilaterally. All the deep tendon reflexes were exaggerated and symmetric, more so in the lower limbs; Plantars were extensor. Romberg's sign was positive. There was no evidence of motor weakness. His cranial nerves were normal. Spine was normal. Vision was normal. Other systemic examination did not reveal any abnormality.