r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2020-25-6-19-28r-n-j-128Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSМиелопатия, ассоциированная с острым лейкозом. Мультидисциплинарный взгляд на проблемуMyelopathy associated with acute leukemia. Multidisciplinary view on the problemhttps://orcid.org/0000-0001-8699-2482ПолушинА. Ю.PolushinA. Yu.alexpolushin@yandex.ruhttps://orcid.org/0000-0002-9769-447XКрасновВ. С.KrasnovV. S.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-3804-6245БардаковС. Н.BardakovS. N.

194044, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0001-5379-2863СкулябинД. И.SkulyabinD. I.

194044, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-0261-3527АгафоновА. О.AgafonovA. O.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0001-8203-3305ВойдакИ. В.VoydakI. V.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-8193-0116БубноваЕ. В.BubnovaE. V.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-6495-700XСергиеняО. В.SergiyenyaO. V.

197341, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0003-4015-6563АюбоваБ. И.AyubovaB. I.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-2446-8092БондаренкоС. Н.BondarenkoS. N.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-0215-4623ВладовскаяМ. Д.VladovskayaM. D.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-4332-0114МоисеевИ. С.MoiseevI. S.

197022, Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-9589-4136КулагинА. Д.KulaginA. D.

197022, Санкт-Петербург

St. Petersburg

ФБГОУ ВО Первый Санкт-Петербургский государственный медицинский университет им. И.П. ПавловаРоссияFirst Pavlov State Medical University of St. PetersburgRussian FederationФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова»РоссияS.M. Kirov Military Medical AcademyRussian FederationФГБУ НМИЦ им. В.А. Алмазова Минздрава РоссииРоссияFederal Almazov North-West Medical Research CentreRussian Federation2020070120212561928Copyright © Полушин А.Ю., Краснов В.С., Бардаков С.Н., Скулябин Д.И., Агафонов А.О., Войдак И.В., Бубнова Е.В., Сергиеня О.В., Аюбова Б.И., Бондаренко С.Н., Владовская М.Д., Моисеев И.С., Кулагин А.Д., 20212021Полушин А.Ю., Краснов В.С., Бардаков С.Н., Скулябин Д.И., Агафонов А.О., Войдак И.В., Бубнова Е.В., Сергиеня О.В., Аюбова Б.И., Бондаренко С.Н., Владовская М.Д., Моисеев И.С., Кулагин А.Д.Polushin A.Y., Krasnov V.S., Bardakov S.N., Skulyabin D.I., Agafonov A.O., Voydak I.V., Bubnova E.V., Sergiyenya O.V., Ayubova B.I., Bondarenko S.N., Vladovskaya M.D., Moiseev I.S., Kulagin A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/128

Ассоциированный с лейкозом миелит является редким, но недооцененным осложнением. Его этиология может быть различна, связана как с основным заболеванием, так и с методами лечения. Миелит требует проведения дифференциальной диагностики с фуникулярным миелозом, полирадикулоневропатией, объемным и геморрагическим образованием, сосудистой ишемией, дисметаболическими проявлениями, а также с последствиями лечения основного заболевания с применением лучевой, цитостатической, таргетной терапии, с паранеопластической миелопатией и прогрессией основного заболевания. Однако выявление его по данным методов нейровизуализации может быть гораздо позже, чем появление развернутой клинической картины. В статье представлен клинический случай развития миелопатии у молодого пациента 31 года с острым лимфобластным лейкозом. Лечение основного заболевания проводилось с применением цитостатической, лучевой терапии, аллогенной трансплантации гемопоэтических стволовых клеток и таргетных препаратов. Характер заболевания (рецидивирующее течение лейкоза), разнообразие методов лечения, отсутствие очаговых изменений при нейровизуализации в зоне, определяющей клинические проявления, обусловили необходимость рассмотрения широкого спектра возможных этиологических факторов развития миелопатии у данного пациента. Миелопатия подтверждена по МРТ спинного мозга спустя 2,5 месяца от дебюта неврологической симптоматики, что соответствует современным представлениям и временным критериям визуализации в нейроонкорадиологии. В статье представлены критерии диагностики миелопатии, являющейся осложнением острого лимфобластного лейкоза.

Leukemia-associated myelitis is a rare but underestimated complication. It has a different etiology associated with both, the main disease and its treatment methods. It requires differential diagnosis with funicular myelosis, polyradiculoneuropathy, tumor and hemorrhagic formation, stroke, dysmetabolic manifestations, as well as with the consequences of treatment of the underlying disease using radiation, cytostatic, targeted therapy.It should also be differentiated from paraneoplastic myelopathy and progression of the underlying disease. However,with the help of neuroimaging methods, it can be detected more recently than a detailed clinical picture appears. A case report of myelopathy in a 31 year old patient with acute lymphoblastic leukemia is presented. Treatment of the underlying disease was carried out with the use of chemotherapy, radiation therapy, allogeneic hematopoietic stem cell transplantation and targeted therapy. The nature of the disease,i.e. recurrent course of acute lymphoblastic leukemia, the variety of treatment methods, and the absence of focal changes in neuroimaging in the zone that determines clinical manifestations, made it necessary to consider a wide range of possible etiological factors for the development of myelopathy. Myelopathy was confirmed by MRI 2.5 months after the debut of neurological symptoms, which corresponds to modern concepts and time criteria for visualization in neurooncology. The article presents the criteria for diagnosing myelopathy, a complication of acute lymphoblastic leukemia. It should also be differentiated from However, with the help of neuroimaging methods, it can be detected more recently than a detailed clinical picture appears.

миелопатияострый лимфобластный лейкозаллогенная трансплантация гемопоэтических стволовых клетокдифференциальная диагностикатаргетная терапиянейролейкемияневрологические осложнения гематологических заболеванийmyelopathyacute lymphoblastic leukemiaallogeneic hematopoietic stem cell transplantationdifferential diagnosistargeted therapyneuroleukemianeurological complications of hematological diseasesReferencesAlakel N., Stölzel F., Mohr B., Kramer M., Oelschlägel U., Röllig C., Bornhäuser M., Ehninger G., Schaich M. Symptomatic central nervous system involvement in adult patients with acute myeloid leukemia. Cancer Manag. Res. 2017;9:97–102. https://doi.org/10.2147/CMAR.S125259Alakel N., Stölzel F., Mohr B., Kramer M., Oelschlägel U., Röllig C., Bornhäuser M., Ehninger G., Schaich M. Symptomatic central nervous system involvement in adult patients with acute myeloid leukemia. Cancer Manag. Res. 2017;9:97–102. https://doi.org/10.2147/CMAR.S125259Frishman-Levy L., Izraeli S. Advances in understanding the pathogenesis of CNS acute lymphoblastic leukaemia and potential for therapy. British Journal of Haematology. 2017;176(2):157–167. https://doi.org/10.1111/bjh.14411Frishman-Levy L., Izraeli S. Advances in understanding the pathogenesis of CNS acute lymphoblastic leukaemia and potential for therapy. British Journal of Haematology. 2017;176(2):157–167. https://doi.org/10.1111/bjh.14411Joseph P., Reyes M. Dorsal Column Myelopathy Following Intrathecal Chemotherapy for Acute Lymphoblastic Leukemia. J. Spinal Cord. Med. 2014;37(1):107–13. https://doi.org/10.1179/2045772312Y.0000000081Joseph P., Reyes M. Dorsal Column Myelopathy Following Intrathecal Chemotherapy for Acute Lymphoblastic Leukemia. J. Spinal Cord. Med. 2014;37(1):107–13. https://doi.org/10.1179/2045772312Y.0000000081Beh S.C., Greenberg B.M., Frohman T., Frohman E.M. Transverse myelitis. Neurol. Clin. 2013;31(1):79–138. https://doi.org/10.1016/j.ncl.2012.09.008Beh S.C., Greenberg B.M., Frohman T., Frohman E.M. Transverse myelitis. Neurol. Clin. 2013;31(1):79–138. https://doi.org/10.1016/j.ncl.2012.09.008Xing L., Wen S., Niu Z., Wang F., Zhang X. Rituximab for acute demyelinating myelopathy after allogeneic hematopoietic stem cell transplantation: a case report. Postgrad. Med. 2020;9:1–4. https://doi.org/10.1080/00325481.2020.1736884Xing L., Wen S., Niu Z., Wang F., Zhang X. Rituximab for acute demyelinating myelopathy after allogeneic hematopoietic stem cell transplantation: a case report. Postgrad. Med. 2020;9:1–4. https://doi.org/10.1080/00325481.2020.1736884Паровичникова Е.Н., Клясова Г.А., Троицкая В.В., Соколов А.Н., Кузьмина Л.А., Менделеева Л.П. и др. Эффективность лечения взрослых больных острым Т-лимфобластным лейкозом по протоколу ОЛЛ-2009 Российской научно-исследовательской группы по изучению острых лейкозов. Тер. архив. 2013;85(8):29–34. URL: https://ter-arkhiv.ru/0040-3660/article/view/31297Parovichnikova E.N., Klyasova G.A., Troitskaya V.V. Sokolov A.N., Kuzmina L.A., Mendeleeva L.P. et al. Efficiency of treatment of adult patients with acute T-lymphoblastic leukemia according to the ALL-2009 protocol of the Russian Acute Leukemia Study Group. Ter. Arch. 2013;85(8):29–34]. URL: https://ter-arkhiv.ru/0040-3660/article/view/31297Kim H.J., Ryu K.N., Choi W.S., Choi B.K., Choi J.M., Yoon Y. Spinal involvement of hematopoietic malignancies and metastasis: differentiation using MR imaging. Clin. Imaging. 1999;23(2):125–33. https://doi.org/10.1016/s0899-7071(99)00105-9Kim H.J., Ryu K.N., Choi W.S., Choi B.K., Choi J.M., Yoon Y. Spinal involvement of hematopoietic malignancies and metastasis: differentiation using MR imaging. Clin. Imaging. 1999;23(2):125–33. https://doi.org/10.1016/s0899-7071(99)00105-9Nguyen T., Palacio A., Beuret-Blanquart F. Paraplegia after intrathecal injection of Methotrexate. Annals of Physical and Rehabilitation Medicine. 2011;54(1):e162–e167. https://doi.org/10.1016/j.rehab.2011.07.513Nguyen T., Palacio A., Beuret-Blanquart F. Paraplegia after intrathecal injection of Methotrexate. Annals of Physical and Rehabilitation Medicine. 2011;54(1):e162–e167. https://doi.org/10.1016/j.rehab.2011.07.513Pan Y., Wang C., Wang H., Tao Q., Xiong S., Zhai Z. Transverse myelopathy occurring with intrathecal administration of methotrexate and cytarabine chemotherapy: A case report. Oncology Letters. 2016;11:4066–4068. https://doi.org/10.3892/ol.2016.4519Pan Y., Wang C., Wang H., Tao Q., Xiong S., Zhai Z. Transverse myelopathy occurring with intrathecal administration of methotrexate and cytarabine chemotherapy: A case report. Oncology Letters. 2016;11:4066–4068. https://doi.org/10.3892/ol.2016.4519Lee H.Y., Sung-il I., Myoung-Hee Kang, Im S-il, Kang M.-H., Kim K.M. et al. Irreversible Paraplegia Following One Time Prophylactic Intrathecal Chemotherapy in an Adult Patient With Acute Lymphoblastic Leukemia. Yonsei Med. J. 2008;49(1):151–4. https://doi.org/10.3349/ymj.2008.49.1.151Lee H.Y., Sung-il I., Myoung-Hee Kang, Im S-il, Kang M.-H., Kim K.M. et al. Irreversible Paraplegia Following One Time Prophylactic Intrathecal Chemotherapy in an Adult Patient With Acute Lymphoblastic Leukemia. Yonsei Med. J. 2008;49(1):151–4. https://doi.org/10.3349/ymj.2008.49.1.151Froklage F.E., Reijneveld J.C., Heimans J.J. Central neurotoxicity in cancer chemotherapy: pharmacogenetic insights. Pharmacogenomics. 2011;12(3):379–95. https://doi.org/10.2217/pgs.10.197Froklage F.E., Reijneveld J.C., Heimans J.J. Central neurotoxicity in cancer chemotherapy: pharmacogenetic insights. Pharmacogenomics. 2011;12(3):379–95. https://doi.org/10.2217/pgs.10.197Dornbos D. 3rd, Elder J., Otero J., Baiocchi R.A., Slone H.W., Puduvalli V.K. et al. Spinal Cord Toxicity From Intrathecal Chemotherapy: A Case With Clinicopathologic Correlation. World Neurosurg. 2019;128:381–384. https://doi.org/10.1016/j.wneu.2019.05.123Dornbos D. 3rd, Elder J., Otero J., Baiocchi R.A., Slone H.W., Puduvalli V.K. et al. Spinal Cord Toxicity From Intrathecal Chemotherapy: A Case With Clinicopathologic Correlation. World Neurosurg. 2019;128:381–384. https://doi.org/10.1016/j.wneu.2019.05.123EMA/289046/2017 Committee for Medicinal Products for Human Use (CHMP). URL: https://www.ema.europa.eu/en/news/meeting-highlights-committee-medicinal-products-human-usechmp-18-21-april-2017EMA/289046/2017 Committee for Medicinal Products for Human Use (CHMP). URL: https://www.ema.europa.eu/en/news/meeting-highlights-committee-medicinal-products-human-usechmp-18-21-april-2017Kelm S., Pelz A., Schauer R., Filbint M.T., Tang S., de Bellard M.-E. et al. Sialoadhesin, Myelin-Associated Glycoprotein and CD22 Define a New Family of Sialic Acid-Dependent Adhesion Molecules of the Immunoglobulin Superfamily. Curr. Biol. 1994;4(11):965–72. https://doi.org/10.1016/s0960-9822(00)00220-7Kelm S., Pelz A., Schauer R., Filbint M.T., Tang S., de Bellard M.-E. et al. Sialoadhesin, Myelin-Associated Glycoprotein and CD22 Define a New Family of Sialic Acid-Dependent Adhesion Molecules of the Immunoglobulin Superfamily. Curr. Biol. 1994;4(11):965–72. https://doi.org/10.1016/s0960-9822(00)00220-7Kantarjian H., Thomas D., Jorgensen J., Kebriaei P., Jabbour E., Rytting M. et al. Results of Inotuzumab Ozogamicin, a CD22 Monoclonal Antibody in Refractory and Relapsed Acute Lymphocytic Leukemia. Cancer. 2013;119(15):2728–2736. https://doi.org/10.1002/cncr.28136Kantarjian H., Thomas D., Jorgensen J., Kebriaei P., Jabbour E., Rytting M. et al. Results of Inotuzumab Ozogamicin, a CD22 Monoclonal Antibody in Refractory and Relapsed Acute Lymphocytic Leukemia. Cancer. 2013;119(15):2728–2736. https://doi.org/10.1002/cncr.28136Vincent A. Developments in autoimmune channelopathies. Autoimmun Rev. 2013;12(6):678–681. https://doi.org/10.1016/j.autrev.2012.10.016Vincent A. Developments in autoimmune channelopathies. Autoimmun Rev. 2013;12(6):678–681. https://doi.org/10.1016/j.autrev.2012.10.016Rajan T.V. The Gell-Coombs Classification of Hypersensitivity Reactions: A Re-Interpretation. Trends Immunol. 2003;24(7):376–9. https://doi.org/10.1016/s1471-4906(03)00142-xRajan T.V. The Gell-Coombs Classification of Hypersensitivity Reactions: A Re-Interpretation. Trends Immunol. 2003;24(7):376–9. https://doi.org/10.1016/s1471-4906(03)00142-xGiometto B., Grisold W., Vitaliani R., Graus F., Honnorat J., Bertolini G., PNS Euronetwork. Paraneoplastic neurologic syndrome in the PNS Euronetwork database: A European study from 20 centers. Arch. Neurol. 2010;67:330–335. https://doi.org/10.1001/archneurol.2009.341Giometto B., Grisold W., Vitaliani R., Graus F., Honnorat J., Bertolini G., PNS Euronetwork. Paraneoplastic neurologic syndrome in the PNS Euronetwork database: A European study from 20 centers. Arch. Neurol. 2010;67:330–335. https://doi.org/10.1001/archneurol.2009.341Liu Z., Jiao L., Qiu Z., Da Y Tanga Y., Lina Y., Lia D. et al. Clinical Characteristics of Patients With Paraneoplastic Myelopathy. J. Neuroimmunol. 2019;330:136–142. https://doi.org/10.1016/j.jneuroim.2019.03.001Liu Z., Jiao L., Qiu Z., Da Y Tanga Y., Lina Y., Lia D. et al. Clinical Characteristics of Patients With Paraneoplastic Myelopathy. J. Neuroimmunol. 2019;330:136–142. https://doi.org/10.1016/j.jneuroim.2019.03.001Chamberlain M.C., Sandy A.D., Press G.A. Neurology. Leptomeningeal metastasis: a comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain. Press GA Neurology. 1990;40(3 Pt 1):435–8. https://doi.org/10.1212/wnl.40.3_part_1.435Chamberlain M.C., Sandy A.D., Press G.A. Neurology. Leptomeningeal metastasis: a comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain. Press GA Neurology. 1990;40(3 Pt 1):435–8. https://doi.org/10.1212/wnl.40.3_part_1.435Del Principe M.I., Maurillo L., Buccisano F., Sconocchia G., Cefalo M., De Santis G. et al. Central Nervous System Involvement in Adult Acute Lymphoblastic Leukemia: Diagnostic Tools, Prophylaxis, and Therapy. Mediterr. J. Hematol. Infect. Dis. 2014;6(1):e2014075. https://doi.org/10.4084/MJHID.2014.075.eCollection 2014Del Principe M.I., Maurillo L., Buccisano F., Sconocchia G., Cefalo M., De Santis G. et al. Central Nervous System Involvement in Adult Acute Lymphoblastic Leukemia: Diagnostic Tools, Prophylaxis, and Therapy. Mediterr. J. Hematol. Infect. Dis. 2014;6(1):e2014075. https://doi.org/10.4084/MJHID.2014.075.eCollection 2014Thomas X., Le Q. Central nervous system involvement in adult acute lymphoblastic leukemia. Hematology. 2008;13(5):293–302. https://doi.org/10.1179/102453308X343374Thomas X., Le Q. Central nervous system involvement in adult acute lymphoblastic leukemia. Hematology. 2008;13(5):293–302. https://doi.org/10.1179/102453308X343374Skullerud K., Halvorsen K. Encephalomyelopathy following intrathecal methotrexate treatment in a child with acute leukemia. Cancer. 1978;42:1211–1215. https://doi.org/10.1002/1097-0142(197809)42:3 < 1211::aid-cncr2820420326 > 3.0.co;2-xSkullerud K., Halvorsen K. Encephalomyelopathy following intrathecal methotrexate treatment in a child with acute leukemia. Cancer. 1978;42:1211–1215. https://doi.org/10.1002/1097-0142(197809)42:3 < 1211::aid-cncr2820420326 > 3.0.co;2-xCachia D., Kamiya-Matsuoka С., Pinnix C.C., Chi L., Kantarjian H.M., Cortes J.E. et al. Myelopathy following intrathecal chemotherapy in adults: a single institution experience. J. Neurooncol. 2015;122(2):391–398. https://doi.org/10.1007/s11060-015-1727-zCachia D., Kamiya-Matsuoka С., Pinnix C.C., Chi L., Kantarjian H.M., Cortes J.E. et al. Myelopathy following intrathecal chemotherapy in adults: a single institution experience. J. Neurooncol. 2015;122(2):391–398. https://doi.org/10.1007/s11060-015-1727-zYong Lee H., Im S., Kang M-H., Kim K.M., Kim S.H., Kim H.-G. et al. Irreversible Paraplegia Following One Time Prophylactic Intrathecal Chemotherapy in an Adult Patient with Acute Lymphoblastic Leukemia. Yonsei Med. J. 2008;49(1):151–4. https://doi.org/10.3349/ymj.2008.49.1.151Yong Lee H., Im S., Kang M-H., Kim K.M., Kim S.H., Kim H.-G. et al. Irreversible Paraplegia Following One Time Prophylactic Intrathecal Chemotherapy in an Adult Patient with Acute Lymphoblastic Leukemia. Yonsei Med. J. 2008;49(1):151–4. https://doi.org/10.3349/ymj.2008.49.1.151Schultheiss T.E. The radiation dose–response of the human spinal cord. Int. J. Radiat. Oncol. Biol. Phys. 2008;71:1455–1459. https://doi.org/10.1016/j.ijrobp.2007.11.075Schultheiss T.E. The radiation dose–response of the human spinal cord. Int. J. Radiat. Oncol. Biol. Phys. 2008;71:1455–1459. https://doi.org/10.1016/j.ijrobp.2007.11.075Wong C.S., Fehlings M.G., Sahgal A. Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord. 2015;53(8):574–80. https://doi.org/10.1038/sc.2015.43Wong C.S., Fehlings M.G., Sahgal A. Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord. 2015;53(8):574–80. https://doi.org/10.1038/sc.2015.43Wong C.S., Van Dyk J., Milosevic M., Laperriere N.J. Radiation myelopathy following single courses of radiotherapy and retreatment. Int. J. Radiat. Oncol. Biol. Phys. 1994;30(3):575–81. https://doi.org/10.1016/0360-3016(92)90943-cWong C.S., Van Dyk J., Milosevic M., Laperriere N.J. Radiation myelopathy following single courses of radiotherapy and retreatment. Int. J. Radiat. Oncol. Biol. Phys. 1994;30(3):575–81. https://doi.org/10.1016/0360-3016(92)90943-cКраснов В.С., Беденко А.С., Тотолян Н.А., Скоромец АА. Продольно распространенный поперечный миелит, ассоциированный с интратекальным синтезом олигоклонального иммуноглобулина G и дефицитом витамина В12. Неврология, нейропсихиатрия, психосоматика. 2016;8(3):71–75. http://dx.doi.org/10.14412/2074-2711-2016-3-71-75Krasnov V.S., Bedenko A.S., Totolyan N.A., Skoromets A.A. Longitudinally extensive transverse myelitis associated with intrathecal synthesis of oligoclonal immunoglobulin G and with vitamin B12 deficiency. Nevrologiya, neiropsikhiatriya, psikhosomatika. Neurology, neuropsychiatry, psychosomatics. 2016;8(3):71–75. (In Russian) http://dx.doi.org/10.14412/2074-2711-2016-3-71-75Flanagan E.P., McKeon A., Lennon V.A., Kearns J., Weinshenker B.G., Krecke K.N. et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. Neurology. 2011b. 76, 2089–2095. https://doi.org/10.1212/WNL.0b013e31821f468fFlanagan E.P., McKeon A., Lennon V.A., Kearns J., Weinshenker B.G., Krecke K.N. et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. Neurology. 2011b. 76, 2089–2095. https://doi.org/10.1212/WNL.0b013e31821f468fHemmer B., Glocker F.X., Schumacher M. Deuschl G., Lücking C.H. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J. Neurol. Neurosurg. Psychiatry. 1998;65:822–827. https://doi.org/10.1136/jnnp.65.6.822Hemmer B., Glocker F.X., Schumacher M. Deuschl G., Lücking C.H. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J. Neurol. Neurosurg. Psychiatry. 1998;65:822–827. https://doi.org/10.1136/jnnp.65.6.822Kumar N., Ahlskog J.E., Klein C.J., Port J.D., Imaging features of copper deficiency myelopathy: a study of 25 cases. Neuroradiology. 2006;48(2):78–83. https://doi.org/10.1007/s00234-005-0016-5Kumar N., Ahlskog J.E., Klein C.J., Port J.D., Imaging features of copper deficiency myelopathy: a study of 25 cases. Neuroradiology. 2006;48(2):78–83. https://doi.org/10.1007/s00234-005-0016-5

The authors declare that there are no conflicts of interest present.