Heart appearance sign, which is usually described in pontine and medullary infarcts  can also occur in Vitamin B12 deficiency.  We present a case vignette of a 24 year old man with progressive sensory ataxia. MRI of the cervico-medullary junction showed diffusion restriction with FLAIR hyperintensity in the nucleus Gracilis and Cuneatus, extending to the upper cervical cord in a heart shaped fashion.  His serum homocysteine level was elevated and he responded remarkably to injection vitamin B12 . Imaging findings in subacute combined degeneration can be confined to the dorsal column nuclei alone sparing the rest of the cervical cord.

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