Teaching NeuroImage: Concomitant Brain and Spine Lesions due to Multiple Nutritional Deficiencies

A 28-year-old vegetarian woman with pernicious anemia developed progressive leg spasticity and psychosis leading to food paranoia and severe malnutrition. She presented with encephalopathy, anemia, hypoalbuminemia, and severe deficiency of zinc and vitamins B1, B6, and B12. MRI revealed a lesion of the splenium of the corpus callosum (figure 1) and spinal cord changes (figure 2). This case shows a combination of findings associated with vitamin deficiencies: corpus callosum (B complex, Marchiafava-Bignami disease)1 and spinal cord (B12, subacute combined degeneration).2 Primary demyelinating, autoimmune, and metabolic disorders (Cu, vitamin E) were ruled out given the clinical context and workup. After treatment, the psychosis resolved; the spasticity and weakness improved.

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