Case 87: Subacute combined degeneration

A 59-year-old man with non–insulin-dependent diabetes mellitus underwent laparoscopic cholecystectomy for biliary stones. He was able to return to work 8 days after surgery. The patient started to experience numbness and tingling in all four limbs 2–3 weeks later. The symptoms progressed to the point that he had difficulty driving, walking, and using his hands. Bladder function was intact. The patient was hospitalized for a complete neurologic evaluation 8 weeks after surgery. A cervical spine magnetic resonance (MR) imaging examination was performed at that time.