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J Korean Soc Emerg Med > Volume 32(5); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(5): 475-479.
T1 강조 자기공명영상에서 조영증강을 보인 척수의 아급성연합변성 환자 증례 소견 1례
조아라1 , 백송이2 , 조준호1
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 영상의학교실
A case of subacute combined degeneration of the spinal cord showing enhancement on T1-weighted MR images
Ara Cho1 , Songee Baek2 , Junho Cho1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Junho Cho ,Tel: 02-2228-2460, Fax: 02-2227-7908, Email: erjoonho@gmail.com,
Received: August 16, 2020; Revised: January 12, 2021   Accepted: March 2, 2021.  Published online: October 31, 2021.
Vitamin B12 deficiency results in the occurrence of systemic diseases in our nervous system. One of the most common manifestations of Vitamin B12 deficiency is subacute combined degeneration (SCD), which is characterized by paralysis and sensory changes of limbs, and disturbance of gait and position sense. SCD can be caused by the abuse of Happy Balloon, which comprises nitrous oxide and is used as a party hallucinogen. Diagnosis of SCD is achieved by combining the clinical symptoms, laboratory study, electrophysiological study and imaging findings. However, neurological symptoms observed during laboratory examinations are insufficient to diagnose SCD without the characteristic magnetic resonance imaging (MRI) findings. This is due to ambiguity of the symptoms and delayed report time of laboratory results in the emergency department. The ‘Inverted V sign’, observed towards the rear of the cervical and thoracic spine in T2 emphasis MRI images, is the most prominent finding of SCD. In most cases, the T1 image shows the same signal strength as the surrounding tissue. In the current report, we present an SCD case with an enhanced T1 phase of the MRI.
Key words: Subacute combined degeneration; Nitrous oxide; Vitamin B12; Magnetic resonance imaging
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