Cervical myelopathy due to chronic vitamin B12 deficiency or herniated cervical disc or both

Objective: A female patient with diagnosis of combined system degeneration due to vitamin B12 deficiency and multi-level cervical disc herniation underwent a comprehensive neurophysiologic tests. Materials and methods: Central conduction time (CCT) was calculated after recording of the SSEPs from cervical, brainstem, and parietal sensory cortex to peripheral stimulation. Results: The CCT between the lower cervical spine and brainstem was 3.63 msec and 3.41 msec for left and right side. All values were within the normal range. The visual EPs and brain-stem auditory EPs were also normal. The MR imaging of the cervical region was remarkable for multi-level degenerative changes as well as osteophyte formation at C4-7 segments causing canal stenosis. Conclusions: It is possible that her symptoms are related to two separate chronic problems. The first is history of B12 deficiency, causing a subacute systems degeneration syndrome. The second is evidence of a cervical spondylotic myelopathy.