A 67-year-old man with a history of terminal ileal resection presents with progressive numbness in his feet and gait instability over 3 months. Vital signs: BP 138/82, HR 88, RR 16, Temp 37°C, SpO2 98%. Examination reveals decreased vibration sense in both feet and bilateral Babinski signs. Serum vitamin B12 level is 185 pg/mL. Cranial nerves are intact. Which of the following is the most likely diagnosis?

  1. A)Transverse myelitis
  2. B)Subacute combined degenerationGABARITO
  3. C)Guillain Barré syndrome
  4. D)Amyotrophic lateral sclerosis
  5. E)Multiple sclerosis

Explicação

Combined dorsal column dysfunction and corticospinal tract signs in a patient at risk for vitamin B12 deficiency indicate subacute combined degeneration. Demyelination of these tracts causes sensory ataxia plus upper motor neuron findings. Ver explicação completa e trilha adaptativa →

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