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Subacute Combined Degeneration and Its Mimickers: Exploring the Pathophysiology and Imaging Features 2014

Category General Spine Brent Griffith Suresh Patel Horia Marin John Corrigan Purpose Subacute combined degeneration (SCD) is a neurologic condition caused by the selective degeneration of posterior and lateral spinal columns due to vitamin B12 deficiency. Despite its characteristic appearance on MR, a number of other entities can mimic the clinical and imaging presentation, resulting in a diagnostic dilemma with treatment implications. The purpose of this exhibit is to review the imaging findings in SCD and its mimickers, as well as discuss the underlying pathophysiology, allowing radiologists to better direct clinicians towards the correct diagnosis. Materials & Methods Cases of subacute combined degeneration and its mimickers will be reviewed. These will include cases of SCD due to vitamin B12 deficiency and nitrous oxide abuse, as well as mimickers including copper deficiency myelopathy, demyelinating disorders, transverse myelitis, and spinal cord infarct. Each case will include a discussion of the clinical presentation, work-up, pertinent imaging findings, and underlying pathophysiology. Results Key Learning Points: 1.) Imaging features of subacute combined degeneration. 2.) Pathophysiology of subacute combined degeneration, as well as potential causes for vitamin B12 deficiency, including common etiologies such as pernicious anemia and more rare causes such as nitrous oxide abuse. 3.) Differential diagnosis for subacute combined degeneration, including those discussed above, specifically focusing on imaging features and clinical tests that may aid in distinguishing these disorders. Conclusion Subacute combined degeneration is an important entity for both radiologists and clinicians to understand, as early detection and treatment is important for full recovery. Therefore, understanding SCD and its potential mimickers, as well as understanding ways to distinguish SCD from other causes of myelopathy can have important implications for patient care. References 1. Ravina B, Loevner LA, Bank W. MR Findings in Subacute Combined Degeneration of the Spinal Cord: A Case of Reversible Cervical Myelopathy. AJR 2000:174: 863-65. 2. Goodman BP,Chong BW, Patel AC, et al. Copper Deficiency Myeloneuropathy Resembling B12 Deficiency: Partial Resolution of MR Imaging Findings with Copper Supplementation. AJNR Am J Neuroradiol 2006:27:2112-14.