Case Challenge Continued: A Woman with Ataxic Gait and Paresthesias

We present the case diagnosis and ask, how would you evaluate the patient further?

The 57-year-old woman presenting with myelopathic symptoms (NEJM JW Neurol Jan 23 2014) had a serum vitamin B₁₂ level that was above the lower end of the laboratory reference range at 206 pg/mL (normal, 180–914 pg/mL). The cerebrospinal fluid (CSF) analysis was unremarkable. The CSF–VDRL and serum FTA-ABS test were both nonreactive. Enzyme-linked immunosorbent assay for HIV antibodies was negative. An electromyography and nerve-conduction study revealed no abnormalities. Brain magnetic resonance imaging (MRI) showed nonspecific white-matter changes (see ). Spine MRI showed signal hyperintensity within the dorsal cervical and thoracic spinal cord (see ), strongly suggestive of a dorsal column myelopathy.

When suspicion of vita…

Authors

Jaime Toro, MD

Disclosures

Editorial BoardsMultiple Sclerosis and Related Disorders

Jaime Toro, MD

Disclosures

Editorial BoardsMultiple Sclerosis and Related Disorders

Saúl Reyes, MD

Maria Camila Bustos, MD

Case Challenge Continued: A Woman with Ataxic Gait and Paresthesias

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