A red tongue and an unsteady gait

We present a case of cobalamin deficiency secondary to chronic autoimmune gastritis resulting clinically in complex combined motor and sensory spinal cord syndrome. Magnetic resonance imaging disclosed increased signal intensity in the dorsal columns of the cervical and thoracic spinal cord on T2-weighted images and the right lateral column stretching from C1 to C6, corresponding with the clinical picture. This is, to our knowledge, the first report of increased signal intensity in lateral columns on T2-weighted images in subacute combined degeneration of spinal cord. The spectrum of clinical symptoms inherent to this disorder, diagnostic tests, with emphasis on magnetic resonance imaging, and treatment are discussed.