Subacute combined degeneration of the spinal cord in vegetarians: vegetarian's myelopathy.

A 49-year-old vegetarian woman developed paresthesia in bilateral arms, forearms, hands and toes. On examination, her position sense was decreased in her hands and toes, but other sensory and motor systems appeared normal. Hyperreflexia was observed in the legs. Babinski’s sign was not seen. Lhermitte’s sign was positive. On cervical MRI scan, T2-weighted images showed bilateral hyperintensities in the posterior column, especially in the fasciculus cuneatus (Fig. 1). Lesions in the lateral column were not obvious. Macrocytic anemia was present and the serum vitamin B12 level was low (123 pg/ml). No abnormal finding was shown on an upper gastrointestinal endoscopic examination. Despite treatment with cyanocobalamin for three months, most of the paresthesia in her hands and toes persisted. A repeat MRI scan showed reduced but residual lesions (Fig. 2). Although subacute combined degeneration of the spinal cord associated with vegetarianism has rarely been reported. (1, 2), clinicians must keep it in mind.