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.

scholarly journals A Case of Subacute Combined Degeneration of Spinal Cord Diagnosed by Vitamin B12 Administration Lowering Methylmalonic Acid

2020 ◽  
Vol 12 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Daisuke Hara ◽  
Masashi Akamatsu ◽  
Heisuke Mizukami ◽  
Bunta Kato ◽  
Takaaki Suzuki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vitamin B12 ◽  
Methylmalonic Acid ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Lower Limbs ◽  
Total Serum ◽  
Subacute Combined Degeneration ◽  
Laboratory Findings ◽  
B12 Deficiency

Subacute combined degeneration of the spinal cord (SCDS) is a neurodegenerative disease characterized by subacute progression in the central and peripheral nervous systems mainly caused by vitamin B12 deficiency. It is known that typical SCDS is frequently accompanied by megaloblastic anemia and increased serum methylmalonic acid (MMA) or homocysteine (Hcy) levels on laboratory findings, and marked abnormalities on spinal cord magnetic resonance imaging (MRI). A 45-year-old woman was admitted to our hospital with a 2-year history of worsening mild weakness, numbness in bilateral lower limbs, and gait disturbance. On admission, as laboratory findings, blood count showed macrocytosis without anemia, and biochemical tests showed mild reduction in total serum vitamin B12 level and no increase of MMA and Hcy levels; there were no abnormal findings on spinal cord MRI. After administration of vitamin B12, her sensorimotor symptoms were improved and laboratory examination showed that macrocytosis was improved, serum vitamin B12 was increased, and serum MMA levels were decreased. This improved clinical course and the laboratory findings following vitamin B12 administration confirmed the diagnosis of SCDS due to vitamin B12 deficiency. SCDS presents with highly variable symptoms and laboratory findings, and observation of MMA levels and neurologic symptoms before and after vitamin B12 administration may be useful for diagnosing SCDS.

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 Autoimmune Polyglandular Syndrome Type II presenting as Subacute Combined Degeneration of Spinal Cord: A Neuroendocrinology Crossroad

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Prateek Bapat ◽  
Suman Kushwaha ◽  
Chirag Gupta ◽  
R Kirangowda ◽  
Vaibhav Seth
Keyword(s):  
Spinal Cord ◽  
Final Diagnosis ◽  
Lower Limbs ◽  
Syndrome Type ◽  
Type Ii ◽  
Subacute Combined Degeneration ◽  
Autoimmune Thyroid ◽  
Systemic Involvement ◽  
Autoimmune Polyglandular Syndrome ◽  
Autoimmune Polyglandular Syndrome Type

Abstract Introduction - Autoimmune polyglandular syndrome (APS) is a condition having multiple endocrine abnormalities. It is divided into three types depending on the involvement of various endocrinopathies. It is also associated with other systemic involvement. The basic pathophysiology of this syndrome revolves around autoimmunity. Case Presentation - We present a 50 year old gentleman who presented to us in emergency with subacute onset progressive weakness of both lower limbs followed by upper limbs. On examination, patient was confused and disoriented. General examination findings include hypotension, pallor, facial puffiness and vitiligo. Neurological examination revealed spasticity and motor weakness in all four limbs with extensor planter response. Sensory examination during hospital course revealed posterior column involvement. Laboratory and radiological investigations confirmed subacute combined degeneration of spinal cord secondary to pernicious anaemia, Addison’s disease and autoimmune thyroid disease. The final diagnosis of autoimmune polyglandular syndrome type II was made after fulfilment of the required criteria. Conclusion – Autoimmune polyglandular syndrome type II can rarely present to neurologist as subacute combined degeneration of spinal cord. This syndrome and its systemic association should be kept in mind in order to reach the final diagnosis.

scholarly journals Clinical-radiological dissociation of a patient with nitrous oxide-induced subacute combined degeneration: A case report

2019 ◽  
Author(s):  
Jiwei Jiang ◽  
Xiuli Shang
Keyword(s):  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Magnetic Resonance Images ◽  
Mri Findings ◽  
Subacute Combined Degeneration ◽  
Posterior Aspect ◽  
T2 Weighted Images

Abstract Background: A number of recent studies have reported subacute combined degeneration (SCD) induced by nitrous oxide (N2O) abuse. However, none have reported the association between the dynamic neuroimaging evolution and clinical manifestations of a patient with N2O-induced SCD. Case presentation: We describe a 24-year-old man who developed SCD with inverted V-sign hyperintensities over the posterior aspect of the spinal cord caused by frequent, excessive N2O inhalation. One month after treatment, his weakness and paresthesia resolved and his serum vitamin B12 level had improved above normal, but the hyperintensities on T2-weighted images had extended horizontally and longitudinally, compared to the initial magnetic resonance images (MRI). Two months after treatment, the patient had some remaining distal limb numbness and normal serum homocysteine level; however, the abnormal signals seen on cervical T2-weighted images had only slightly decreased compared to those seen on the one-month follow-up MRI. The evolution of conventional MRI findings lagged behind the clinical manifestation, suggesting a clinical-radiological dissociation. Conclusions: The clinical-radiological dissociation may have occurred in this case because the T2-weighted imaging did not have sufficient sensitivity to reveal cytotoxic edema. Additionally, the serum vitamin B12 level was not a good indicator of cellular vitamin B12. Clinicians should, therefore, recognize this phenomenon, comprehensively assess the condition of patients with N2O-induced SCD, and avoid terminating treatment based on the resolution of clinical symptoms and serological results.

scholarly journals Subacute combined degeneration of spinal cord vs Miller-Fisher syndrome: a diagnostic challenge

2021 ◽  
Author(s):  
Mário Luciano de Mélo Silva Júnior ◽  
Roberta Lorena de Farias Souza ◽  
Marcos Vinícius de Souza Vilanova ◽  
Marcos Holmes Carvalho
Keyword(s):  
Spinal Cord ◽  
Rapid Test ◽  
Pulse Therapy ◽  
Position Sense ◽  
Miller Fisher Syndrome ◽  
Lower Limbs ◽  
Sensory Level ◽  
Diagnostic Challenge ◽  
Subacute Combined Degeneration ◽  
Fisher Syndrome

Context: Ataxic syndromes in the emergency department have a vast differential diagnosis, including immune, nutritional, and other etiologies. Case report: Man, 67yo, alcoholic, but previously healthy, came to ED due to complaints of falls and progressive dysesthesia in lower limbs which started 7 days from admission. He denied other toxic exposures or infectious history, except covid-19 one month before the current symptoms. Physical examination revealed mild hoarseness, left hemipalate paresis, tactile and position sense hypoesthesia, no sensory level, absence of profound reflexes; right hypotonia, global ataxia, and he was unable to walk. Neuroaxis MRI was normal. CSF obtained at D10 had 2 lymphocytes/mm3, 96mg/dL of proteins and no other abnormalities. Hb=13g/ dL, VCM=103fL, B12=424pg/mL, LDH and homocysteine were high. Negative anti-HTLV and -transglutaminase; covid-19 rapid test was positive, but rt-PCR was negative. ENMG revealed moderate sensory-motor axonal polyneuropathy. We hypothesized that the main differential diagnoses were subacute combined degeneration of spinal cord (although high level of protein in CSF) and Miller-Fisher syndrome (although ophthalmoparesis was absent). Considering that there was no motor nor respiratory symptoms, we did not offer pulse therapy and opted for B12 vitamin replacement. The patient had a favorable response to therapies and was able to walk at two weeks of treatment. Conclusions: We did not define the etiology of this case, however, it is important to keep B12 deficiency in mind (even when it is into the lab reference range) and to pay attention to post-viral atypical manifestations, mostly in the context of the current covid-19 pandemic.

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