Nitrous Oxide Abuse‐Induced Subacute Combined Degeneration: Classic Neuroimaging Findings on MRI

Neurographics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 72-74
Author(s):  
A.K. Kirsch ◽  
S.M. Allison ◽  
S.A. Kilanowski
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Mr Imaging ◽  
Young Patient ◽  
Patient Population ◽  
High Signal ◽  
Vitamin B ◽  
Subacute Combined Degeneration ◽  
Dorsal Columns ◽  
Delay In Treatment

Subacute combined degeneration is uncommonly a result of nitrous oxide abuse and presents with high signal in the dorsal columns of the spinal cord on T2-weighted MR imaging. We present a case of subacute combined degeneration in a young patient who abused nitrous oxide, which is an uncommon cause and infrequently seen in this patient population. Symptoms are often reversible with treatment of vitamin B12, and radiologists should be aware of these findings to avoid delay in treatment.

scholarly journals Subacute Combined Degeneration of the Spinal Cord due to Different Etiologies and Improvement of MRI Findings

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Azize Esra Gürsoy ◽  
Mehmet Kolukısa ◽  
Gülsen Babacan-Yıldız ◽  
Arif Çelebi
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Neurological Complication ◽  
Vitamin B12 Deficiency ◽  
Vegetarian Diet ◽  
Mri Findings ◽  
Subacute Combined Degeneration ◽  
B12 Deficiency ◽  
Reversible Condition

Subacute combined degeneration (SCD) is a rare neurological complication of vitamin B12 deficiency, characterized by demyelination of the dorsal and lateral spinal cord. Herein, we describe three cases, who presented with SCD, one related to reduced intake of vitamin B12 because of a vegetarian diet and two related to nitrous oxide exposure during surgery. MR images of our patients revealed symmetrical hyperintense signals in dorsal and lateral columns in T2 weighted series. After treatment with intramuscular B12 injections (1 mg daily for 2 weeks, once weekly thereafter for three months) all patients showed improvement of their symptoms. Abnormalities of the spinal cord on MRI resolved in three months. In conclusion, SCD either due to nitrous oxide exposure or due to reduced intake of vitamin B12 is a reversible condition, when detected and treated early.

Subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia

2009 ◽  
Vol 30 (1) ◽  
pp. 75-76 ◽  
Author(s):  
Dimitri Renard ◽  
Anais Dutray ◽  
Anouck Remy ◽  
Giovanni Castelnovo ◽  
Pierre Labauge
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Subacute Combined Degeneration ◽  
Nitrous Oxide Anaesthesia ◽  
Oxide Anaesthesia

scholarly journals Recreational Nitrous Oxide-Induced Subacute Combined Degeneration of the Spinal Cord

Cureus ◽  
2021 ◽  
Author(s):  
Priyal Agarwal ◽  
Si Yuan Khor ◽  
Steven Do ◽  
Lawrenshey Charles ◽  
Richa Tikaria
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Subacute Combined Degeneration

scholarly journals Clinical and MRI Differences Between Patients With Subacute Combined Degeneration of the Spinal Cord Related vs. Unrelated to Recreational Nitrous Oxide Use: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Han Gao ◽  
Weishuai Li ◽  
Jing Ren ◽  
Xiaoyu Dong ◽  
Ying Ma ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Functional Disability ◽  
Young Patients ◽  
Serum Vitamin ◽  
Lower Limbs ◽  
Imaging Features ◽  
Subacute Combined Degeneration ◽  
Imaging Characteristics ◽  
Unsteady Gait

Objective: To explore the clinical and imaging characteristics of subacute combined degeneration of the spinal cord (SCD) related to recreational nitrous oxide (N2O) use.Methods: Clinical and imaging data were retrospectively collected from patients with SCD related to recreational N2O use who were diagnosed and treated at Shengjing Hospital of China Medical University from January 2016 to June 2020. The clinical and imaging features of patients with recreational N2O-related SCD were compared with those of patients with N2O-unrelated SCD, who were diagnosed and treated during the same period of time.Results: The study enrolled 50 patients (male/female: 22/28, age: 21.4 ± 4.7 years) with N2O-related SCD and 48 patients (male/female: 27/21, age: 62.0 ± 11.4 years) with SCD unrelated to N2O use. The most common signs/symptoms of the patients in both groups were limb numbness and weakness and unsteady gait, but the incidence of limb weakness, unsteady gait, disorders of urination and defecation, anorexia, reduced deep sensation in lower limbs, ataxia, and positive Babinski sign were lower in the N2O-related SCD group than those in the N2O-unrelated SCD group (P < 0.05). The functional disability rating score of patients in the N2O-related SCD group (median: 3, IQR: 2–5) was also significantly lower than the score in the N2O-unrelated SCD group (median: 5, IQR: 4–7) (P < 0.05). The serum vitamin B12 level was significantly lower in the N2O-unrelated SCD group (median: 96 pg/mL, IQR: 50–170 pg/mL) than the level in the N2O-related SCD group (median: 218 pg/mL, IQR:121–350 pg/mL) (P < 0.05), while both groups had similarly increased levels of homocysteine (P > 0.05). Compared with the N2O-unrelated SCD patients, more patients with N2O-related SCD had abnormal spinal magnetic resonance imaging (MRI) scans (80.0 vs. 64.2%). The patients with N2O-related SCD also had wider spinal lesions on sagittal MRI (5.3 ± 0.8 mm vs. 4.2 ± 1.0 mm), fewer spinal segments with lesions (median: 5, IQR: 4–6 segments vs. median: 6, IQR: 5–7.5 segments), and a higher incidence of the inverted V sign on axial MRI (72.0 vs. 31.2%) (all P < 0.05).Conclusion: The recreational use of N2O has become an important cause of SCD in young patients. Compared with the N2O-unrelated SCD patients, the N2O-related SCD patients had less severe clinical presentations, less obvious decrease in serum VB12 levels, and more obvious MRI changes.

Autoimmune gastritis concomitant with gastric adenoma and subacute combined degeneration of the spinal cord

2021 ◽  
Vol 14 (5) ◽  
pp. e242836
Author(s):  
Masahiro Taniguchi ◽  
Gota Sudo ◽  
Yuzufumi Sekiguchi ◽  
Hiroshi Nakase
Keyword(s):  
Spinal Cord ◽  
Histopathological Examination ◽  
Intrinsic Factor ◽  
Pernicious Anaemia ◽  
Autoimmune Gastritis ◽  
Gastric Neoplasms ◽  
Gastric Body ◽  
Vitamin B ◽  
Gastric Adenoma ◽  
Subacute Combined Degeneration

A 62-year-old woman was referred to our department for further investigation of anaemia. Blood test showed macrocytic anaemia. Oesophagogastroduodenoscopy (OGD) revealed proximal-predominant gastric atrophy and flat elevated lesion in the gastric body. Several days after OGD, she complained of gait disturbance and was diagnosed with subacute combined degeneration of the spinal cord. Furthermore, laboratory tests showed positive for both anti-parietal cell and anti-intrinsic factor antibodies, as well as increased serum gastrin level and decreased pepsinogen I level, which confirmed the diagnosis of autoimmune gastritis (AIG). Anaemia and neurological symptoms were improved after vitamin B12 supplementation. Subsequently, the patient underwent gastric endoscopic submucosal dissection; histopathological examination revealed gastric adenoma. AIG can cause gastric neoplasms and vitamin B12 deficiency, with the latter resulting in pernicious anaemia and neurological disorders. These diseases are treatable but potentially life-threatening. This case highlights the importance of early diagnosis of AIG and proper management of its comorbidities.

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