LAUSR

A 57-year-old Japanese man presented to our hospital with progressive gait disturbance for 4 months. He had a history of alcohol use disorder. There was a loss of vibratory sensation in the lower extremities, and the Romberg sign was positive. Laboratory studies revealed that the hemoglobin level was 6.3 g/dL (reference range, 13.5 to 17.6 g/dL), the mean corpuscular volume was 127.7 fL (reference range, 82.7 to 101.6 fL), the vitamin B12 concentration was below the level of detectability, and the patient was positive for anti-intrinsic factor antibodies. Upper gastrointestinal endoscopy revealed atrophic gastritis. Cervical, thoracic, and lumbar spine magnetic resonance imaging (MRI) showed high intensity of the posterior cord (Picture A, C, arrowheads). We diagnosed subacute combined degeneration of the spinal cord and initiated vitamin B12 supplementation (1). The clinical symptoms gradually improved with