A 39 year-old woman with history of alcohol abuse was admitted for a recent fall due to alcohol intoxication. On evaluation, she reported chronic ascending numbness in both lower extremities since summer 2018 which was also affecting both arms by September 2019. She was previously evaluated for idiopathic polyneuropathy, deemed to be secondary to alcohol abuse, with a negative work up including normal MRI neuroaxis, negative autoimmune/paraneoplastic panel and vitamin B12 of 418 pg/ml tested a year prior. Patient described recent onset of gait imbalance and paresthesias to her mid-abdomen. After this fall she additionally complained of numbness and pain in the arms.
On examination, there was a T10 sensory level and absent proprioception and vibratory sensation affecting bilateral lower extremities. Extensive work up showed undetectable Vitamin B1, low B12 206 pg/ml, low ceruloplasmin 7.9 mg/dl, with negative VDRL and normal TSH, Folate, copper, and zinc. There was a high Cu/Zn ratio of 1.74. MRI spine showed T2 hyperintensity within posterior columns involving the entire cervical and thoracic cord.