A retrospective study of 23 cases with subacute combined degeneration

Li, Jiasi; Ren, Ming; Dong, Aisheng; Wu, Yuncheng; Han, Ning; Deng, Bo; Bi, Xiaoying

doi:10.3109/00207454.2015.1077331

Cited by 19 publications

(20 citation statements)

References 17 publications

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“…In this case, serum methylmalonic acid and homocysteine levels are more accurate to reflect vitamin B12 functional statuses. 18,19 In our study, 27 of the 33 patients presented with high homocysteine levels, which was consistent with previous reports. Therefore, our results suggested that the level of homocysteine is a better biomarker for diagnosis of N 2 O-induced neurological disorders and a normal serum vitamin B 12 level cannot be used to exclude genuine vitamin B 12 deficiency and damage in this condition.…”

Section: Mri Findingssupporting

confidence: 93%

<p>Clinical, Electrophysiological and Radiological Features of Nitrous Oxide-Induced Neurological Disorders</p>

Bao¹,

Li²,

Li³

et al. 2020

NDT

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These authors contributed equally to this workPurpose: We summarized the clinical manifestations, laboratory and electrodiagnostic characteristics and magnetic resonance imaging (MRI) findings of nitrous oxide (N 2 O) abuse-induced neurological disorders. Patients and Methods: We retrospectively reviewed 33 patients with N 2 O abuse-induced neurological disorders and reported their demographic data, clinical manifestations, laboratory examinations, nerve conduction studies, together with spinal and brain MRI. Results: The most frequent clinical manifestations included numbness and weakness in the extremities and unspecified gait disturbance. Low serum vitamin B 12 levels were found in 9 patients, and high homocysteine levels were noted in 27 patients. Nerve conduction studies showed a sensory-motor neuropathy. Sixteen patients showed bilateral high-intensity T2 signal within the posterior column on spinal MRI, and four patients showed cerebral white matter lesions on brain MRI. Conclusion: N 2 O abuse has become a significant public health problem because of the severe neurological disorders related to chronic abuse. Clinical physicians should be aware of the toxic effects of N 2 O.

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Section: Mri Findingssupporting

confidence: 93%

<p>Clinical, Electrophysiological and Radiological Features of Nitrous Oxide-Induced Neurological Disorders</p>

Bao¹,

Li²,

Li³

et al. 2020

NDT

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“…Our MRI studies had a sensitivity of 44.1%. This is higher than the 14.8% (Jain et al [19]), 22.2% (Hemmer et al [11]), and 26.1% (Li et al [2]) sensitivities reported in some previous studies, but lower than the 52.8% sensitivity reported by Xiao et al [22] The following reasons may explain the low detection rate. First, the current approach may not be able to detect micro-lesions of the spinal cord.…”

Section: Discussioncontrasting

confidence: 52%

“…All the patients met the diagnostic criteria of SCD with modification: (1) clinical symptoms and signs of posterior and lateral columns or peripheral nerve impairment; (2) evidence of vitamin B 12 deficiency or clinical improvement after regular vitamin B 12 treatment in patients with normal or increased serum vitamin B 12 level; and (3) no other spinal cord or peripheral nerve disease [2]. The histories of the patients were well-documented.…”

Section: Methodsmentioning

confidence: 99%

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

Cao

et al. 2018

Eur Neurol

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Purpose: The study aimed to analyze the clinical characteristics, laboratory test results, neuroimaging findings, and outcomes in patients diagnosed with subacute combined degeneration (SCD). Materials and Methods: A total of 68 patients with SCD who had been appropriately treated for no less than 6 months were included in our study. Histories, results of routine blood tests, biochemical indices, serum vitamin B₁₂ levels, and spinal magnetic resonance imaging (MRI) findings from the patients were studied and analyzed. Clinical signs and symptoms, graded using a functional disability rating scale, were scored at the time of admission and 3 and 6 months after admission. Results: Limb numbness, limb weakness, and gait disturbances were the most common symptoms in patients with SCD. All patients showed clinical improvement to different degrees at the follow-up visits after vitamin B₁₂ treatment. No differences in rating score were found in patients grouped by sex, hemoglobin level, serum vitamin B₁₂, or MRI manifestations at the time of admission or at the follow-up visits. Younger patients and those with shorter disease courses had better rating scores at the short-term follow-up visits. Conclusion: Anemia, low levels of serum vitamin B₁₂, and MRI abnormalities in the spinal cord are not expected to be associated with worse clinical manifestations. The age of onset and course of disease are important in evaluating the short-term prognosis of patients with SCD.

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“…Many SCD cases with typical sensory deficits similar to our patients have been reported in previous literature [1,2,6], but there are only few SCD cases showing severe motor weakness [7]. As our two patients presented low Cbl levels and typical sensory deficits of SCD, Cbl deficiency would be suggested as a main cause of SCD.…”

Section: Discussionsupporting

confidence: 79%

Motor Dominant Polyneuropathy with Subacute Combined Degeneration of the Spinal Cord following Nitrous Oxide Abuse

Lee

Kwon

et al. 2020

J Electrodiagn Neuromuscul Dis

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Nitrous oxide (N 2 O) is utilized mainly for anesthetic purposes. However, these days the gas is abused in a form dubbed 'happy balloon' among the young generation for recreational purposes in nightclubs or bars. N 2 O gas interferes with cobalamin (Cbl) metabolisms, leading to axonal degeneration and a failure of my-Nitrous oxide (N 2 O) is known to induce cobalamin (vitamin B12, Cbl) deficiency, leading to myeloneuropathies. We describe two patients who present Cbl deficiency after N 2 O abuse for several months. They complained weakness of both lower limbs and gait disturbance. Their magnetic resonance imaging demonstrated high signal intensities on the dorsal columns of the spinal cord at C2-C5 on T2 weighted images, suggestive of subacute combined degeneration (SCD). Initial electrodiagnostic studies resulted in demyelinating and axonal motor dominant polyneuropathies (PNs). In these cases, Cbl deficiency due to N 2 O inhalation was suspected as the primary cause for SCD. Cbl deficiency, however, is mainly known to affect sensory nerves, and therefore difficult to account for the motor dominant PNs in our cases. Based on such fact, we suggested that N 2 O-induced motor dominant PN may occur independently from Cbl deficiency in SCD patients.

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A retrospective study of 23 cases with subacute combined degeneration

Abstract: The sensory symptoms occur earlier than the motor symptoms in SCD patients. SCD patients may have sensory deficit level. Normal or even elevated serum levels of vitamin B12 may occur in patients with SCD.

Cited by 19 publications

References 17 publications

<p>Clinical, Electrophysiological and Radiological Features of Nitrous Oxide-Induced Neurological Disorders</p>

<p>Clinical, Electrophysiological and Radiological Features of Nitrous Oxide-Induced Neurological Disorders</p>

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

Motor Dominant Polyneuropathy with Subacute Combined Degeneration of the Spinal Cord following Nitrous Oxide Abuse

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