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Subacute combined degeneration of spinal cord - nitrous oxide

Case contributed by Jay Gajera
Diagnosis certain

Presentation

Three to 5 days onset of bilateral distal limb paresthesia and ataxia, positive Romberg, impaired proprioception and vibration sense.

Patient Data

Age: 30 years
Gender: Male

There is diffuse symmetric bilateral high T2 signal within the dorsal columns of the spinal cord (inverted V sign), beginning at the level of C1 and extending to the upper thoracic cord. Axial T2WI not performed through the thoracic cord to accurately determine the lower level of the extent of signal change.

No abnormal contrast enhancement within the cord.

Case Discussion

This patient used nitrous oxide extensively for recreational purposes. Findings are most consistent with subacute combined degeneration of the cord.

The differential diagnosis for this appearance includes neurosyphilis (tabes dorsalis).

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