A 42-year-old woman is brought to the hospital because of difficulty breathing and progressive palpitation. Despite the emergency team intervention, she dies. She had a history of atrial fibrillation treated with anticoagulation therapy. Autopsy reveals a large epidural hemorrhage with brain herniation; spinal cord evaluation reveals symmetric myelin layer vacuolization and axonal degeneration involving the posterior columns and the lateral corticospinal tracts. Which of the following is the most likely cause of this patient's spinal cord findings?

Question

A 42-year-old woman is brought to the hospital because of difficulty breathing and progressive palpitation. Despite the emergency team intervention, she dies. She had a history of atrial fibrillation treated with anticoagulation therapy. Autopsy reveals a large epidural hemorrhage with brain herniation; spinal cord evaluation reveals symmetric myelin layer vacuolization and axonal degeneration involving the posterior columns and the lateral corticospinal tracts.  Which of the following is the most likely cause of this patient's spinal cord findings?

Quizplus · Accepted Answer

Eductional Objective: Myelopathy associated with vitamin B₁₂ deficiency is called subacute combined degeneration. "Combined" refers to myelin degeneration of both the ascending (dorsal columns) and descending (corticospinal tract) pathways. Loss of position and vibration sensation, sensory ataxia, and spastic paresis are common manifestations.

A 42-Year-Old Woman Is Brought to the Hospital Because of Difficulty