4 CONCLUSION AND RESULTS (OUTCOME AND FOLLOW UP)
Follow up cervical spine MRI showed bilaterally symmetrical T2
hyperintense signals in the posterior aspect of the cord in the dorsal
columns, showing an inverted V sign without post-contrast enhancement
and extending from C2 to C6 vertebrae (Figure 2). Vitamin B12 was
115pg/ml (<200 is deficient, 200-300 is borderline
and>300pg/ml is sufficient). TSH was normal and HbA1C was
5.7% (prediabetes range). EMG/NCS revealed acute on chronic motor axon
loss changes affecting L5-S1 and left C8-T1 segments/myotomes with
evidence of a mild sensory polyneuropathy affecting lower limbs with
reduced bilateral sural nerve sensory amplitudes. These findings were
suggestive of vitamin B12 deficiency and macrocytic anemia, which led to
SCD with DVT.