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Images in Neurology |

Longitudinally Extensive Nitrous Oxide Myelopathy With Novel Radiographic Features

Lia D. Ernst, MD1; Kenneth Brock, BA1; Luis H. Barraza, MD1; Adam Davis, MD2; Melissa J. Nirenberg, MD, PhD1
[+] Author Affiliations
1Department of Neurology, NYU School of Medicine, New York, New York
2Department of Radiology, NYU School of Medicine, New York, New York
JAMA Neurol. 2015;72(11):1370-1371. doi:10.1001/jamaneurol.2015.2141.
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This case report describes a previously healthy 30-year-old man who developed limb paresthesias and incoordination. Initial magnetic resonance imaging was normal, but over the subsequent 8 weeks, he developed a bandlike sensation across the torso and profound sensory ataxia.

A previously healthy 30-year-old man developed limb paresthesias and incoordination. Initial magnetic resonance imaging of the spinal cord, performed 5 weeks after symptom onset, was normal (Figure, A). Over the subsequent 8 weeks, he developed a bandlike sensation across the torso and profound sensory ataxia. He was admitted to the neurology service for further evaluation. Motor examination showed mild (4+) weakness in the distal lower greater than upper extremities. Sensation to vibration and proprioception was absent in the lower extremities and markedly diminished in the distal upper extremities. There was no spinal sensory level to pinprick or temperature modalities. There was moderate dysmetria on heel-knee-shin greater than finger-nose-finger tests; the Romberg sign was present. Deep tendon reflexes were 2+ in the upper extremities and 3+ in the lower extremities. Plantar responses were extensor on the right and flexor on the left. Over 5 days of hospitalization, the patient became unable to walk or stand unsupported because of severe sensory ataxia.

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Figure.

Spinal cord magnetic resonance imaging (MRI). A, Spinal cord MRI was initially normal, shown on sagittal short T1 inversion recovery. B, Eight weeks later, the same sequence demonstrated longitudinally extensive hyperintensity with associated spinal cord expansion. C, Sagittal T1 postgadolinium images demonstrate prominent dorsal column enhancement. D, In axial sections (shown at the C3 level), there is inverted V-shaped gadolinium enhancement. E, An axial T2 image (also at C3) further characterizes the observed extensive pattern of hyperintensity.

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