Vitamin B12 deficiency mimicking neuroimaging features of motor neuron disease

Deficiência de vitamina B12 mimetizando aspectos de neuroimagem da doença do neurônio motor

A 45-year-old man presented with 2-month-history of progressive gait disturbances and behavioral changes. Examination showed vibration sense compromise and pyramidal signs of release. Blood test revealed low serum vitamin B12 (120 pg/mL; normal range>200 pg/mL). Brain MRI disclosed hyperintense signal in corticospinal tracts, a similar pattern observed in motor neuron disease (MND) (Figure). Replacement therapy was started and there were motor and cognitive improvements.

Figure
. (A) Axial T2-weighted and (B) axial FLAIR-weighted brain MRI disclosing multiple frontal hyperintense signal changes in corticospinal tracts projections, a similar pattern observed in motor neuron disease. (C) Axial MTC sequence is normal, and no contrast enhancement was observed.

Vitamin B12 deficiency may present with different neurological syndromes ¹ . Encephalopathy related to B12 deficiency presents with nonspecific white matter changes ² . Although MTC brain MRI sequence was normal, our patient presented neuroimaging features observed in MND ³ .

References

• ¹
  Kalita J, Misra UK. Vitamin B12 deficiency neurological syndromes: correlation of clinical, MRI and cognitive evoked potential. J Neurol 2008;255:353-359.
• ²
  Sudo K, Tashiro K. Cerebral white matter lesions associated with vitamin B12 deficiency. Neurology 1998;51:325-326.
• ³
  Lee YC, Markus R, Hughes A. MRI in ALS: corticospinal tract hyperintensity. Neurology 2003;61:1600.

Publication Dates

• Publication in this collection
  Jan 2014

History

• Received
  15 July 2013
• Accepted
  23 July 2013