Tunis Med. 2020 Dec;98(12):1042-1045.
Biermer's anemia is an auto immune disease that can lead to neurological manifestations. Medullary combined sclerosis accounts for only 10% of neurological complications. There are few reports of documented bone marrow involvement by magnetic resonance imaging (MRI). Observation: We report a case of combined sclerosis of the cervical spinal cord assessed by cerebro-medullary MRI in a context of vitamin B12 deficiency in a 36-year-old patient who was hospitalized in the intensive care unit for septic shock with respiratory starting point, requiring the use of mechanical ventilation for 13 days and the discovery in post-extubation of pancytopenia with macrocytic anemia and flasquo-spasmodic tetraparesis prompting an emergency MRI showing combined sclerosis of the spinal cord , with vitamin B12 deficiency and megaloblastic anemia at the myelogram. The patient had benefited of vitamin therapy combined with a physical rehabilitation and the evolution was marked by a recovery of walking and normalization of biology after 2 months. Conclusion: The advantage of medullary MRI in a severe clinical form with neurological impairment of vitamin B12 deficiency to guide the diagnosis. The treatment is based on vitamin therapy with a good evolution.
比默尔贫血是一种自身免疫性疾病，可导致神经表现。骨髓联合硬化症仅占神经并发症的 10%。很少有骨髓受累的磁共振成像（MRI）记录报告。观察：我们报告了一例 36 岁患者的颈脊髓联合硬化症病例，该患者因败血症性休克伴有呼吸起点而入住重症监护病房，需要使用机械通气 13 天，并在拔管后发现全血细胞减少症伴有巨红细胞性贫血和痉挛性四肢瘫痪，促使紧急进行 MRI 检查，显示脊髓联合硬化症、维生素 B12 缺乏和骨髓巨幼细胞性贫血。患者接受了维生素治疗联合物理康复治疗，2 个月后，患者的行走能力恢复，生物学指标恢复正常，病情得到缓解。结论：在伴有神经功能障碍的严重临床形式的维生素 B12 缺乏症中，骨髓 MRI 的优势在于指导诊断。治疗基于维生素治疗，预后良好。
