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A 50-year-old strict vegetarian lady presented with progressive gait instability and paraesthesia of all four limbs lasting 8 months. She had spastic ataxic quadriparesis with pan sensory loss below the C3/4 spinal segment, sensory polyneuropathy, prolonged visual evoked potentials and unrecordable somatosensory evoked potentials. Her serum vitamin B12 concentration was 78 pg/ml. Spinal MRI showed …
Competing interests: None.
Patient consent: Obtained.