V for vitamin, inverted V for lack of it: A rare case of subacute combined degeneration of cord with bladder symptoms and associated multiple Tarlov cysts

Subacute degeneration of cord (SACD) is a rare presentation of a common disease and it should be kept in mind when the patient develops symptoms of peripheral neuropathy. This is a case of a 65-year-old male who presented with pins and needles sensation of bilateral hands and feet and with difficulty in voiding. Neurological examination showed large fiber neuropathy with an exaggerated knee jerk, absent ankle jerk, extensor plantar, and a positive Romberg’s sign. Routine laboratory investigations showed low hemoglobin and low vitamin B12 levels. Magnetic resonance imaging of the spinal cord showed a hyperintense lesion in the posterior aspect of the cervical cord with a classical “inverted V” sign on the axial section which is suggestive of SACD. Coincidentally, there were multiple Tarlov cysts present. Finally, the patient improved with vitamin B12 injections. This case is unique as an association of SACD with Tarlov cysts with a classical inverted V sign has not been reported according to the literature.

A Study of Foramina Thyroideum.

Background: A foramen in the lamina of thyroid cartilage is an occasional opening existing in one or both thyroid laminae which may or may not contain a neurovascular component. Foramen was first described by Segond in 1847. Materials and methods: Larynx specimens were collected from Department of Forensic Medicine Mysore Medical College. 62 Larynx specimens were collected, 31 male and 31 female, and fixed in 10% formalin solution for 2- 3 weeks. Careful dissection was done to separate thyroid cartilage and following observations were made. Location of foramen, regarding the side of lamina and its relation to oblique line was noted. Size, shape and measurements were noted. Results: Foramina were observed in the laminae of 9 thyroid cartilages in females and 6 in male specimens. 1 male specimen showed bilateral foramina thyroideum. Among 16 Foramina Thyroideum (FT), 13 were on right lamina and 3 on left lamina. Shape of FT was round in 9 specimens and oval in 7 specimens. 10 FT were located in front of oblique line, 5 were behind and 1 was on the line. Size of FT range from 1mm - 5.67mm, close to upper boarder in 13 specimens and 3 were in the middle.1 specimen showed presence of superior laryngeal vessels in FT. Conclusions: Incidence of FT in the present study was 25.8%.To conclude presence of FT being a rare variation clinicians need to be aware of the possible contents such as external and internal laryngeal nerve communication and presence of superior laryngeal vessels before undertaking surgical procedures.