Subacute Combined Degeneration: A Retrospective Study of 68 Cases with Short-Term Follow-Up

Cao, Jie; Su, Zhuyi; Xu, Shabei; Liu, Chenchen

doi:10.1159/000488913

Cited by 35 publications

(49 citation statements)

References 24 publications

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“…However, to the best of our knowledge, none of these studies have reported a relationship between the evolution of dynamic neuroimaging and clinical manifestations in a patient with N 2 O-induced SCD. Treatment is frequently discontinued by individuals who abuse N 2 O following improvement in the neurological symptoms [3]. Moreover, guidelines for treatment duration have not been established for patients with SCD.…”

Section: Introductionmentioning

confidence: 99%

Clinical-radiological dissociation in a patient with nitrous oxide-induced subacute combined degeneration: a case report

Jiang

Shang

2020

BMC Neurol

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Background: Several recent studies have reported subacute combined degeneration (SCD) induced by nitrous oxide (N 2 O) abuse. However, the association between the evolution of dynamic neuroimaging and clinical manifestations has not been reported in patients with N 2 O-induced SCD. Case presentation: We described the case of 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 N 2 O inhalation. One month after treatment, his weakness and paresthesia resolved and serum vitamin B 12 levels exceeded the normal levels. However, the hyperintensities had extended horizontally and longitudinally on T2-weighted magnetic resonance imaging (MRI), compared to those on the initial scan. Two months after treatment, the patient experienced some residual numbness in the distal limbs, and his serum homocysteine levels were normal, but the abnormal signals seen on cervical T2-weighted MRI had decreased only slightly compared to those seen on the one-month follow-up MRI. The evolution of conventional MRI findings lagged compared to the clinical manifestation, which was suggestive of a clinical-radiological dissociation. Conclusions: Clinical-radiological dissociation might have occurred in this case because T2-weighted imaging was not sensitive enough to reveal cytotoxic edema. Moreover, the serum vitamin B 12 level is not a good indicator of cellular vitamin B 12. Thus, clinicians should recognize this phenomenon, comprehensively assess the condition of patients with N 2 O-induced SCD, and avoid terminating treatment based on the resolution of clinical symptoms and serological results.

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Section: Introductionmentioning

confidence: 99%

Clinical-radiological dissociation in a patient with nitrous oxide-induced subacute combined degeneration: a case report

Jiang

Shang

2020

BMC Neurol

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“…In contrast to many other etiologies of SCD, N2O-mediated inactivation of B12 is not consistently tied to hematologic symptoms (e.g. macrocytic anemias) as might be expected in other causes of SCD such as pernicious anemia [ 11 , 12 ]. In both anesthetic and recreational use, worsened clinical manifestations are not expected to be associated with anemia, low levels of serum vitamin B12, or MRI abnormalities in the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…In both anesthetic and recreational use, worsened clinical manifestations are not expected to be associated with anemia, low levels of serum vitamin B12, or MRI abnormalities in the spinal cord. The age of onset and disease course are important factors in evaluating the short-term prognosis of patients with SCD [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The courses of symptom resolution could not be tied to sex, hemoglobin level, serum vitamin B12, or MRI manifestations at the time of admission or at the follow-up visits. However, both younger patients and those with shorter disease courses had better rating scores for self-perceived clinical improvement at the short-term follow-up visits [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was measured to be approximately 19 kg in one month, including 15 kg over the five days preceding symptom onset. Additionally, as opposed to most cases of SCD, this patient presented with B12 values within normal limits, as inactivated B12 cannot be discerned from normal, active B12 [ 11 ]. Other laboratory values, including elevated homocysteine and methylmalonic acid levels, were consistent with all causes of SCD [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Subacute Combined Degeneration Secondary to Nitrous Oxide Abuse: Quantification of Use With Patient Follow-up

Samia

Nenow

Price

2020

Cureus

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Subacute combined degeneration (SCD) is caused by demyelination of spinal cord white matter secondary to vitamin B12 (cobalamin) deficiency leading to core symptoms of spastic paresis and vibratory and proprioceptive deficits. Most common causes of B12 deficiency revolve around malabsorption and pernicious anemia; however, nitrous oxide (N2O) can also indirectly cause B12 deficiency by inactivating its biologically active form. We report a case of a patient who took advantage of the unregulated N2O market and presented with signs and symptoms of SCD secondary to N2O abuse. Prior to symptom onset, the patient reported approximately 3,000g of N2O inhalation within five days prior to symptom onset in addition to daily use three weeks prior. Work up revealed laboratory and imaging abnormalities consistent with SCD, although B12 levels were normal intrinsic-factor-blocking (IFB) antibodies were present. Appropriate treatment was undertaken, and the patient was followed up at one week and one month with noticeable clinical improvements. Similarities of this patient to literature include the classic presenting symptoms of SCD and the gradual symptomatic improvement with B12 injections and N2O abstinence. This case is remarkable due to SCD occurrence after recreational N2O abuse, objective quantification of N2O intake over a specified time period to induce SCD, occurrence secondary to N2O inhalation, positive IFB antibodies, and symptomatic presentation with B12 values within normal limits. This report highlights the dangers associated with N2O abuse and moving forward awareness of this case can be referenced to aid in educating members of our communities at risk for substance abuse.

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Nitrous oxide‐related neurological disorders: Clinical, laboratory, neuroimaging, and electrophysiological findings

et al. 2021

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Background: Recreational N 2 O abuse is an important etiology of neurological impairment in young patients, which may easily be ignored clinically. Few current studies have investigated the characteristics or the effects experienced by its users. We aimed to explore any correlation between the clinical severity and biomarkers and spinal magnetic resonance imaging (MRI) abnormalities, identify independent factors associated with spinal MRI abnormalities, and ascertain factors affecting depression/anxiety in patients with N 2 O-related neurological disorders.Methods: Patients with N 2 O-related neurological disorders were enrolled retrospectively between February 2017 and July 2020. Their demographic, clinical, laboratory, neuroimaging, electrophysiological, and neuropsychological findings were analyzed.Correlation analyses were conducted using Spearman's or Pearson's correlation and linear regression analysis. Independent factors associated with spinal MRI abnormalities were identified using univariate and multivariate analyses. Results:The principal clinical manifestations of N 2 O-related neurological disorders (n = 63; 38 men, 25 women; mean age ± SD: 22.60 ± 4.46 years) were sensory disturbance, followed by gait disturbance and pyramidal tract damage. A significant negative correlation existed between serum vitamin B 12 levels and clinical severity (r = −0.309, p = .014), which disappeared after linear regression. An interval of less than 6 months between initial N 2 O abuse and hospitalization was independently associated with spinal MRI abnormalities (39.47% vs. 72.00%, respectively; χ 2 = 6.40, p = .01). Thirtyeight (60.32%) and 40 (63.49%) patients experienced anxiety and depression, respectively. Moreover, the higher the clinical scores/serum homocysteine levels, the greater the severity of anxiety/depression (r = 0.442, p < .01; r = 0.346, p < .01; r = 0.477, p < .01; r = 0.324, p < .01). Conclusions:The significant inverse correlation between initial vitamin B 12 levels and clinical severity could aid prognosis prediction in patients with N 2 O-related neurological disorders. Spinal MRI abnormalities were not related to clinical severity butThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Subacute Combined Degeneration: A Retrospective Study of 68 Cases with Short-Term Follow-Up

Cited by 35 publications

References 24 publications

Clinical-radiological dissociation in a patient with nitrous oxide-induced subacute combined degeneration: a case report

Clinical-radiological dissociation in a patient with nitrous oxide-induced subacute combined degeneration: a case report

Subacute Combined Degeneration Secondary to Nitrous Oxide Abuse: Quantification of Use With Patient Follow-up

Nitrous oxide‐related neurological disorders: Clinical, laboratory, neuroimaging, and electrophysiological findings

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