Subacute combined degeneration of the cervical and dorsal spinal cord in a 40-year-old male patient: A case report

Abnormal brain changes in a patient with vegetarian diet‑induced subacute combined degeneration: A case report

Subacute combined degeneration (SCD) is a neurological disorder caused by vitamin B12 deficiency, prevalent in the cervical and thoracic medullas, with an insidious onset and a lack of characteristic clinical manifestations. The present study describes a case of a 36-year-old female patient with SCD who demonstrated abnormal changes in the white matter of the brain. The laboratory test results showed a decrease in serum vitamin B12 levels and an increase in homocysteine levels. Magnetic resonance imaging (MRI) of the brain showed that, in addition to abnormal signals in the cervical and thoracic spine, speckled and short-striped abnormal signals were present, symmetrically distributed in the centrum semiovale. After 6 months of follow-up treatment, cranial MRI showed a significant attenuation of the symmetrical speckled and short-striped abnormal signals in the centrum semiovale. Homocysteine and serum vitamin B12 levels of the patient were within the expected range. Although, to the best of our knowledge, there have been no previous reports of alterations in the brain of patients with SCD, if these patients report neurological symptoms, clinicians should consider that these symptoms may be accompanied by inflammatory demyelination of the brain.

A case of subacute combined degeneration of the spinal cord diagnosed with difficulty due to a history of treatment for pyogenic spondylitis

Early diagnosis of spinal cord subacute combined degeneration (SCD) is difficult, especially in pre-existing lower extremity impairment cases. We report a case of progressive SCD diagnosed after severe anemia. The peripheral symptoms of SCD other than gait disturbance should also be well understood and given close attention.

Subacute Combined Degeneration of the Spinal Cord Secondary to Nitrous Oxide Abuse

Here, we report a case of subacute combined degeneration (SCD) of the spinal cord in the setting of nitrous oxide poisoning seen at the Medical Ward, Queen Elizabeth Hospital Birmingham Our patient was a 28-year-old lady who presented with impaired sensations in the lower limbs and difficulty walking for approximately one and a half months. Her clinical symptoms did not match common neurological conditions. Upon detailed history, she revealed that she had been frequently using nitrous oxide recreationally for several years. Although her baseline investigations were normal, her magnetic resonance imaging (MRI) of the spine showed bilateral symmetrical T2 hyperintense signal changes in the dorsal columns extending from C2 to C6 spinal segment. Based on history, clinical findings, and MRI of the cervical spine, the diagnosis of SCD of the spinal cord was made, and her symptoms fully resolved with treatment.

An unusual case of subacute combined degeneration due to nitrous oxide abuse, which relapsed after bariatric surgery: A case report

RATIONALE

Several studies have reported subacute combined degeneration (SCD) induced by nitrous oxide (N2O) abuse. However, few studies have reported that N2O-induced SCD recurred because of sleeve gastrectomy after neurological symptoms improved.

PATIENT CONCERNS

We report the case of an 18-year-old woman who developed paresthesia, weakness in 4 limbs, and an unstable gait after frequent, excessive N2O inhalation.

DIAGNOSIS

The patient was diagnosed as having SCD.

INTERVENTIONS AND OUTCOMES

Nineteen days after intravenous mecobalamin and supplementation with other kinds of vitamin B, her weakness and paresthesia resolved. However, 7 months after discharge, the patient experienced recurrence following sleeve gastrectomy. Blood biochemistry revealed low vitamin B12 levels. After a 22-day treatment, similar to the first hospitalization, her residual numbness and unsteady gait improved.

LESSONS

This case highlights that patients, especially those at high risk of vitamin B12 deficiency, undergoing sleeve gastrectomy require careful nutritional follow-up and routine monitoring of micronutrients such as vitamin B12 and homocysteine. Continuous vigilance is essential for patients with common and rare neurological complications.