Combined degeneration of the cord

Case contributed by Dr Sjoert Pegge


Progressive strange sensations in both hands extending to the knees. Intoxication: Nitrous oxide.

Patient Data

Age: 25
Gender: Male

At presentation MRI shows T2 hyperintensity in the posterior aspect of the cervicothroacic spinal cord. The hyperintensity is bilaterally located in the dorsal columns. The axial T2 images show the so-called inverted V-sign.

Due to disturbing motion artefacts the axial T2 of the cervical spine is not included. 

Follow up MRI after 7 weeks: MRI shows subtle T2 hyperintensity at the cervical spine.

Case Discussion

Patients use of Nitrous Oxide, MRI characteristics and symtoms improvement after starting Vit B12 therapy are consistent with subacute combined degeneration of the cord.

In this case the usage of N2O is considerd causative as it disturbes the pathways of intracellular vitamin B12 metabolism.

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Case information

rID: 43982
Published: 1st Apr 2016
Last edited: 14th Aug 2019
System: Spine
Inclusion in quiz mode: Included

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