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.