1. Subcortical lesions due to cobalamin deficiency: an unusual MRI lesion pattern.
- Author
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Kremmyda O, Forbrig R, Heinrich J, Winkler T, and Straube A
- Subjects
- Adult, Amygdala diagnostic imaging, Gyrus Cinguli diagnostic imaging, Humans, Insular Cortex diagnostic imaging, Magnetic Resonance Imaging, Male, Spinal Cord diagnostic imaging, Spinal Cord pathology, Vitamin B 12 Deficiency diagnostic imaging, Amygdala pathology, Gyrus Cinguli pathology, Insular Cortex pathology, Vitamin B 12 Deficiency pathology
- Abstract
We present a 44-year-old male patient with new onset of right focal epilepsy and bilateral hand hypesthesia. Cerebral MRI showed bilateral T2w/DWI hyperintense subcortical lesions in the cingulate gyrus, insula, and amygdala, whereas spinal MRI revealed a cervical posterior column lesion, corresponding to subacute combined degeneration. Laboratory workup revealed a cobalamin deficiency due to type A gastritis, and no evidence of antibodies associated with limbic encephalitis. After sufficient cobalamin substitution, the cerebral and spinal lesions gradually regressed. Our case represents a unique cerebral subcortical MRI lesion pattern in a patient with epilepsy and cobalamin deficiency. Thus, the latter represents an important differential diagnosis for autoimmune encephalitis.
- Published
- 2021
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