RESUMO
Evolving subacute myelopathies have many possible etiologies. This is a report of a patient who presented with progressive paresthesias, proprioceptive loss, and gait disturbance with acute myelitis seen on magnetic resonance imaging initially concerning for transverse myelitis. However, she also had vitamin B12 deficiency, and her clinical course ultimately suggested a diagnosis more compatible with subacute combined degeneration. The clinical features, laboratory, and imaging findings and prognosis of the 2 disorders are compared. LEVEL OF EVIDENCE: V.
Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética/métodos , Mielite Transversa/diagnóstico , Medula Espinal/patologia , Degeneração Combinada Subaguda/diagnóstico , Diagnóstico Diferencial , Terapia por Exercício , Feminino , Humanos , Degeneração Combinada Subaguda/reabilitação , Adulto JovemAssuntos
Alcoolismo/complicações , Anemia Perniciosa/complicações , Degeneração Combinada Subaguda/reabilitação , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Alcoolismo/reabilitação , Anemia Perniciosa/reabilitação , Humanos , Masculino , Óxido Nitroso , Degeneração Combinada Subaguda/etiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
We describe a case of a young woman who developed myelopathy and peripheral neuropathy following 1 year of recreational nitrous oxide (N2O) use. She presented with uncomfortable tingling sensation in her feet and poor balance. Physical examination revealed mild weakness and hyper-reflexia in the lower limbs. Proprioception and vibration were absent in the lower limbs. Pinprick and light touch sensations were reduced below the sixth thoracic dermatome. A broad-based gait and a positive Romberg sign were noted. The level of vitamin B12 was low (76 pmol/l). T2-weighted MRI scans showed hyperintensity changes at the posterior column from the second to the fifth cervical vertebrae. She made a full recovery following injections of vitamin B12 and physiotherapy. This case discusses subacute combined degeneration of the spinal cord on a background of N2O abuse.
