Question 2481
{"accessible":true,"alternatives":[{"id":12191,"text":"colonoscopy to assess for inflammatory bowel disease"},{"id":12192,"text":"CSF analysis for oligoclonal bands"},{"id":12193,"text":"DSA to identify artery of Adamkiewicz"},{"id":12194,"text":"MRI brain for optic neuritis"},{"id":12195,"text":"serum B12 measurement"}],"archived":false,"correctAlternativeId":12195,"explanation":"\u003cp\u003eThe appearance on this axial T2W\u0026nbsp;cervical spine shows dorsal column T2W hyperintensity in a \"inverted V\" or \"rabbit ear\" pattern. This is typical for \u003cstrong\u003esubacute combined degeneration of the cord\u003c/strong\u003e.\u003c/p\u003e\u003cp\u003eThis is associated with a systemic \u003cstrong\u003eB12 deficiency\u003c/strong\u003e\u0026nbsp;and typically responds to replacement therapy. Other mineral, electrolyte and vitamin disturbances (including copper, vitamin E) can share these appearances.\u003c/p\u003e\u003cp\u003eB12 abnormality can occur in inflammatory bowel disease or\u0026nbsp;GI surgery, typically involving the\u0026nbsp;distal / terminal ileum.\u003c/p\u003e\u003cp\u003eDorsal column involvement can also be seen in neuroinflammatory conditions including multiple sclerosis and longitudinally extensive transverse myelitis (such as neuromyelitis optica). Ischemic insults can involve the dorsal cord, but due to the normal arterial supply would typically be unilateral.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e","id":2481,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/485/axial_t2w_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":34641},"imageAttributionCaseInfo":{"title":"Subacute combined degeneration of the cord","contributor_name":"Christine Goh","contributor_param":"christine-goh","case_rid":34641,"case_param":"subacute-combined-degeneration-of-the-cord-2"},"firstQuestionPath":"/questions/2481","nextQuestionPath":"/articles/subacute-combined-degeneration-of-the-cord-1/questions/1464","relatedArticles":[],"alsoUsedIn":[{"id":1344,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1344","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1344"},{"id":1200,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1200","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1200"},{"id":248,"kind":"LiveSchedule","title":"248","link":"https://radiopaedia.org/admin/live_schedules/248"},{"id":155,"kind":"LiveSchedule","title":"155","link":"https://radiopaedia.org/admin/live_schedules/155"},{"id":1269,"kind":"Course","title":"2022 Virtual Conference Private Use - page 1269","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/1269"},{"id":1269,"kind":"Course","title":"CT \u0026 MRI Lectures - page 1269","link":"https://radiopaedia.org/courses/ct-mri-lectures/pages/1269"}],"stem":"\u003cp\u003eThis adult patient\u0026nbsp;with reduced upper and lower limb\u0026nbsp;sensation and balance\u0026nbsp;has this finding on their MRI cervical spine. What next investigation would be most useful?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2481"}],"attemptsPercentages":[{"alternativeId":"12195","percentage":82},{"alternativeId":"12194","percentage":8},{"alternativeId":"12191","percentage":1},{"alternativeId":"12192","percentage":6},{"alternativeId":"12193","percentage":3}],"promptToLogin":false,"questionManager":false,"articleId":"subacute-combined-degeneration-of-the-cord"}