Volume 21 Issue 1
Jan.  2023
Turn off MathJax
Article Contents
CHENG Chen, YU Wen-ke, CHEN Yong, YU Xin-feng, LU Xiao-dong. Clinical and radiological analysis of subacute combined degeneration caused by different etiologies[J]. Chinese Journal of General Practice, 2023, 21(1): 50-53. doi: 10.16766/j.cnki.issn.1674-4152.002809
Citation: CHENG Chen, YU Wen-ke, CHEN Yong, YU Xin-feng, LU Xiao-dong. Clinical and radiological analysis of subacute combined degeneration caused by different etiologies[J]. Chinese Journal of General Practice, 2023, 21(1): 50-53. doi: 10.16766/j.cnki.issn.1674-4152.002809

Clinical and radiological analysis of subacute combined degeneration caused by different etiologies

doi: 10.16766/j.cnki.issn.1674-4152.002809
Funds:

 2021ZB224

  • Received Date: 2022-07-11
    Available Online: 2023-04-07
  •   Objective  This study aims to compare the clinical, radiological features and outcomes between patients with subacute combined degeneration (SCD) induced by recreational nitrous oxide (N2O) abuse and patients with N2O-unrelated SCD.  Methods  From January 2017 to April 2021, the clinical data of 43 patients with SCD diagnosed at Affiliated Hospital of Hangzhou Normal University, Sir Run Run Shaw Hospital Zhejiang University and Zhejiang Second Hospital were retrospectively analysed. According to the etiology, case data were divided into 23 patients with recreational N2O-induced SCD and 20 patients with N2O-unrelated SCD. The clinical and MRI features, laboratory tests and prognosis were compared between the two groups.  Results  Of the 23 patients with recreational N2O-induced SCD, the mean age of onset was lower than those with N2O-unrelated SCD [21 (19, 25) vs. 69 (62, 74) years, P < 0.001]]. The incidence of urinary and stool dysfunction was lower in the N2O-induced SCD group (34.78%, 8/23) than in the N2O-unrelated SCD group (65.00%, 13/20, P=0.048). MRI examinations indicated the N2O-induced SCD cases presented a higher incidence of cord swelling [56.52% (13/23) vs. 20.00% (4/20), P=0.015]. The mRS scores for patients with N2O-induced SCD [3.0 (2.5, 4.0)] were lower than those with N2O-unrelated SCD [4.0 (3.5, 4.0), P=0.033] at admission. Moreover, patients with N2O-induced SCD presented significantly lower mRS [2.0 (1.0, 2.0)] scores than those with N2O-unrelated SCD [3.0 (3.0, 4.0), P < 0.001] at the last follow-up visit 3 months later.  Conclusion  These findings indicated that patients with N2O-induced SCD have less severe neurological function deficit, an increased incidence of cord swelling and better prognosis.

     

  • loading
  • [1]
    中华医学会神经病学分会, 中华医学会神经病学分会周围神经病协作组, 中华医学会神经病学分会肌电图与临床神经电生理学组, 等. 中国亚急性联合变性诊治共识[J]. 中华神经科杂志, 2020, 53(4): 269-273. doi: 10.3760/cma.j.cn113694-20191101-00677

    Chinese Society of Neurology, Peripheral Neuropathy Cooperative Group, Electromyography and Clinical Neurophysiology Group, Chinese Society of Neurology, et al. Chinese expert consensus on diagnosis and treatment of subacute combined degeneration[J]. Chinese Journal of Neurology, 2020, 53(4): 269-273. doi: 10.3760/cma.j.cn113694-20191101-00677
    [2]
    CAO J, SU Z Y, XU S B, et al. Subacute combined degeneration: a retrospective study of 68 cases with short-term follow-up[J]. Eur Neurol, 2018, 79(5-6): 247-255. doi: 10.1159/000488913
    [3]
    GREEN R, ALLEN L H, BJORKE-MONSEN A L, et al. Vitamin B (12) deficiency[J]. Nat Rev Dis Primers, 2017, 3(1): 17040. doi: 10.1038/nrdp.2017.40
    [4]
    CHEN R, LIAO M, OU J. Laughing gas inhalation in Chinese youth: a public health issue[J]. Lancet Public Health, 2018, 3(10): e465. DOI: 10.1016/S2468-2667(18)30134-8.
    [5]
    KEDDIE S, ADAMS A, KELSO A R C, et al. No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation[J]. J Neurol, 2018, 265(5): 1089-1095. doi: 10.1007/s00415-018-8801-3
    [6]
    ZHENG D M, BA F, BI G R, et al. The sharp rise of neurological disorders associated with recreational nitrous oxide use in China: a single-center experience and a brief review of Chinese literature[J]. J Neurol, 2020, 267(2): 422-429. doi: 10.1007/s00415-019-09600-w
    [7]
    BUHRE W, DISMA N, HENDRICK J, et al. European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice[J]. Br J Anaesth, 2019, 122(5): 587-604. doi: 10.1016/j.bja.2019.01.023
    [8]
    ALLEN L H, MILLER J W, DE GROOT L, et al. Biomarkers of Nutrition for Development (BOND): vitamin B-12 review[J]. J Nutr, 2018, 148(4): 1995S-2027S. DOI: 10.1093/jn/nxy201.
    [9]
    LEWIS B, NELSON G, VU T, et al. No laughing matter-Myeloneuropathy due to heavy chronic nitrous oxide abuse[J]. Am J Emerg Med, 2021, 46(8): 799e1-799e2.
    [10]
    ROBERT H D, MARTINEZ B, TABAAC B J. B12 deficiency and clinical presentation in the setting of nitric oxide use[J]. Case Rep Neurol Med, 2021, 2021(4): e5590948. DOI: 10.1155/2021/5590948.
    [11]
    ZHANG J J, XIE D D, ZOU Y F, et al. Key characteristics of nitrous oxide-induced neurological disorders and differences between populations[J]. Front Neurol, 2021, 12(4): e627183. DOI: 10.3389/fneur.2021.627183.
    [12]
    王瑞, 梁娜娜, 孙亚丽, 等. 笑气滥用致神经系统损害的临床特征[J]. 徐州医科大学学报, 2019, 39(5): 350-353. doi: 10.3969/j.issn.2096-3882.2019.05.009

    WANG R, LIANG N N, SUN Y L, et al. Clinical features of nervous system damage caused by nitrous oxide abuse[J]. Journal of Xuzhou Medical University, 2019, 39(5): 350-353. doi: 10.3969/j.issn.2096-3882.2019.05.009
    [13]
    FANG X, LI W, GAO H, et al. Skin hyperpigmentation: a rare presenting symptom of nitrous oxide abuse[J]. Clinical toxicology, 2020, 58(6): 476-481. doi: 10.1080/15563650.2019.1665181
    [14]
    SWART G, BLAIR C, LU Z, et al. Nitrous oxide-induced myeloneuropathy[J]. Eur J Neurol, 2021, 28(12): 3938-3944. doi: 10.1111/ene.15077
    [15]
    XIANG Y Y, LI L, MA X T, et al. Recreational nitrous oxide abuse: prevalence, neurotoxicity, and treatment[J]. Neurotox Res, 2021, 39(3): 975-985. doi: 10.1007/s12640-021-00352-y
    [16]
    YUAN J L, WANG S K, JIANG T, et al. Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: A case report and literature review[J]. BMC neurology, 2017, 17(1): 222-224. doi: 10.1186/s12883-017-0990-3
    [17]
    NOH T, OSMAN G, CHEDID M, et al. Nitrous oxide-induced demyelination: Clinical presentation, diagnosis, and treatment recommendations[J]. J Neurol Sci, 2020, 414(7): e116817. DOI: 10.1016/j.jns.2020.116817.
    [18]
    EINSIEDLER M, VOULLEMINOT P, DEMUTH S, et al. A rise in cases of nitrous oxide abuse: neurological complications and biological findings[J]. J Neurol, 2021, 1-6. DOI: 10.1007/s00415-021-10702-7.
    [19]
    林妮, 柯渠青, 蒋玲燕, 等. 同型半胱氨酸临床应用的研究进展[J]. 中华全科医学, 2021, 19(8): 1358-1361. doi: 10.16766/j.cnki.issn.1674-4152.002060

    LIN N, KE Q Q, JIANG L Y, et al. The clinical application value of homocysteine[J]. Chinese Journal of General Practice, 2021, 19(8): 1358-1361. doi: 10.16766/j.cnki.issn.1674-4152.002060
    [20]
    VOLLHARDT R, MAZOYER J, BERNARDAUD L, et al. Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic[J]. J Neurol, 2021, 1-6. DOI: 10.1007/s00415-021-10748-7.
    [21]
    WILLIAMSON J, HUDA S, DAMODARAN D. Nitrous oxide myelopathy with functional vitamin B12 deficiency[J]. BMJ Case Reports, 2019, 12(2): e227439. DOI: 10.1136/bcr-2018-227439.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(5)

    Article Metrics

    Article views (245) PDF downloads(6) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return