MRI of spinal cord and brain lesions in subacute combined degeneration

Katsaros, Vasileios K.; Glocker, F.X.; Hemmer, B.; Schumacher, Martin

doi:10.1007/s002340050670

Cited by 70 publications

(56 citation statements)

References 5 publications

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“…Hyperactivity in the cerebellar hemispheres have been demonstrated with positron emission tomography in PWT, and it is known that these structures may be affected by vitamin B12 deficiency [6]. There is only one case of postural and kinetic tremor due to vitamin B12 deficit reported in the last 13 years [4] and, like in our patient, it was quickly resolved after correction of this deficit.…”

supporting

confidence: 65%

Writing Tremor as a Manifestation of Vitamin B12 Deficiency

Guijarro-Castro¹,

Estallo-Guijarro²

2017

Arch Med

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Postural and kinetic tremor due to vitamin B12 deficit is rare in adults, but secondary writing tremor due this deficit is more unusual. We report the case of a writing tremor patient that was resolved after cyanocobalamin treatment. An 80-year-old man presented with a three-month history of trembling on his right hand, only becoming apparent when writing. He suffered from hypertension and diabetes, had no familial history recorded, and did not take dopaminergic-block drugs. Neurologic examination showed a fine, rapid tremor of the hands that began immediately after the patient began to write. Results of the rest of the examination were normal. Results of laboratory tests were normal, except for a serum vitamin B12 level of 132 ng per liter (normal range, 222 ng/l to 753 ng/l). A Schilling test demonstrated malabsorption of vitamin B12. A magnetic resonance image of the brain was normal. Surface electromyogram showed a 7 Hz synchronous tremor of the flexor and extensor muscles of the forearm that began when the patient was writing and was absent in other actions. Electrophysiological studies also showed mild sensory axonal polyneuropathy. Clonazepam (1 mg per day) and cyanocobalamin (injections of 1000 µg given daily for two weeks, then weekly for two months, and once a month thereafter) provided complete relief of the tremor. Follow-up after one year showed no abnormalities. Then, treatment with clonazepam was discontinued, without recurrence of the tremor. Task-specific tremor is a form of action tremor that occurs when a person is performing a specific task [1]. The most frequent form of task-specific tremor is writing tremor (WT). The pathophysiology of WT is not clear and could be a variant of essential tremor or a type of focal dystonia or an independent entity [2]. However, the results in cortical inhibition during taskspecific contractions indicate that WT is not a variant of focal task-specific dystonia, but rather an independent entity [3]. WT typically occurs at a frequency of 5 Hz to 7 Hz. The writing tremor may progress to another task specific tremor of specific action, or rest tremor, but not to postural tremor. Tremor temporary suppression by alcohol is observed in about one-third of the cases, and beneficial responses to propranolol, primidone, anticholinergics, botulinum toxin treatment, and stereotactic surgery has been reported [2].Although the association of tremor in adults with vitamin B12 deficiency is very rare [4,5], the patient's tremor disappeared after vitamin B12 supplements, which supports this association. Hyperactivity in the cerebellar hemispheres have been demonstrated with positron emission tomography in PWT, and it is known that these structures may be affected by vitamin B12 deficiency [6]. There is only one case of postural and kinetic tremor due to vitamin B12 deficit reported in the last 13 years [4] and, like in our patient, it was quickly resolved after correction of this deficit. The tremor is a characteristic symptom of vitamin B12 deficiency in children, but not know...

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supporting

confidence: 65%

Writing Tremor as a Manifestation of Vitamin B12 Deficiency

Guijarro-Castro¹,

Estallo-Guijarro²

2017

Arch Med

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“…5 Standard treatment for more than six months was not effective, and seven patients required oxygen therapy (five at enrollment and two during the treatment phase). Since patients with idiopathic pulmonary fibrosis invariably have progressive disease, the absence of more severe disease in any of these patients is very unusual, especially given that there were three to seven years of follow-up.…”

Section: Interferon Gamma-1b For the Treatment Of Idiopathic Pulmonarmentioning

confidence: 97%

“…Preoperative imaging should chiefly be considered if previous surgical exploration has failed. 5 P AUL G LENDENNING , M.B., C H .B. …”

Section: Treatment Of Primary Hyperparathyroidismmentioning

confidence: 99%

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Shaky-Leg Syndrome and Vitamin B₁₂Deficiency

Benito‐León¹,

Porta‐Etessam²

2000

N Engl J Med

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“…It is considered the most common metabolic myelopathy. [1][2][3] intestinal infections and ileal abnormalities (Helicobacter pylori, Diphyllobothrium latum, human immunodeficiency virus, intestinal tuberculosis or lymphoma, celiac disease, Whipple's disease, inflammatory bowel disease, radiation enteritis, graft-versus-host disease, pancreatic disease, ZollingerEllison syndrome, and tropical sprue, bacterial overgrowth) lead to malabsorption 1,4 . Other conditions include elderly (related to atrophic gastritis-related hypochlorhydria induced food-Vitamin B 12 malabsorption), hereditary enzymatic defects and mutations in genes encoding endocytic receptors involved in ileal absorption and cellular Cbl uptake (Mutations in CUBN and AMN (selective Cbl malabsorption and proteinuria: Imerslund-Grasbeck syndrome), mutations in gastric intrinsic factor (GIF) or TCN2 (transcobalamin) leading to absence of the protein or presence of abnormal protein, disorders of intracellular processing and utilization of vitamin B 12 , disorders involving the synthesis of cobalamin cofactors (cblA to cblG), and medications (Antacids, H2 blockers, metformin, sunitinib).…”

Section: Myelopathies Associated With Nutrient Deficienciesmentioning

confidence: 99%

Toxic and Metabolic Myelopathies

Ramalho

Nunes

Rocha

et al. 2016

Seminars in Ultrasound, CT and MRI

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Myelopathy describes any neurologic deficit related to the spinal cord. It is most commonly caused by its compression by neoplasms, degenerative disc disease, trauma, or infection. Less common causes of myelopathy include spinal cord tumors, infection, inflammatory, neurodegenerative, vascular, toxic, and metabolic disorders. Conditions affecting the spinal cord must be recognized as early as possible to prevent progression that may lead to permanent disability. Biopsy is rarely performed, thus the diagnosis and management rely on patient's history, physical examination, laboratory results, and imaging findings. Here we review the clinical presentations, pathophysiological mechanisms, and magnetic resonance imaging findings of myelopathies related to metabolic or toxic etiologies. Semin Ultrasound CT MRI 37:448-465 C 2016 Elsevier Inc. All rights reserved.

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MRI of spinal cord and brain lesions in subacute combined degeneration

Cited by 70 publications

References 5 publications

Writing Tremor as a Manifestation of Vitamin B12 Deficiency

Writing Tremor as a Manifestation of Vitamin B12 Deficiency

Shaky-Leg Syndrome and Vitamin B₁₂Deficiency

Toxic and Metabolic Myelopathies

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MRI of spinal cord and brain lesions in subacute combined degeneration

Cited by 70 publications

References 5 publications

Writing Tremor as a Manifestation of Vitamin B12 Deficiency

Writing Tremor as a Manifestation of Vitamin B12 Deficiency

Shaky-Leg Syndrome and Vitamin B12Deficiency

Toxic and Metabolic Myelopathies

Contact Info

Product

Resources

About

Shaky-Leg Syndrome and Vitamin B₁₂Deficiency