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Background <p>Recreational nitrous oxide (N₂O) abuse has become a common health issue in young adults, which can induce subacute combined degeneration (SCD) of the spinal cord. Neurosyphilis has highly similar clinical and imaging manifestations with SCD. The coexistence of N₂O-induced SCD and asymptomatic neurosyphilis is extremely rare and easily overlooked. We herein report such a case to improve clinical diagnosis.</p> Case presentation <p>A 23-year-old female presented with 3-month progressive limb numbness and gait instability, with a 6-month history of N₂O inhalation. Spinal MRI showed typical “inverted V-sign” of SCD. Further examinations confirmed asymptomatic neurosyphilis, severe vitamin B12 deficiency and hyperhomocysteinemia. After standard combined treatment, her neurological function was significantly improved with no recurrence during follow-up.</p> Conclusion <p>For young patients with spinal cord lesions, screening for N₂O abuse, vitamin B12 and syphilis should be performed simultaneously. Early diagnosis and combined intervention can effectively avoid permanent neurological damage.</p>

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A case report of nitrous oxide-induced subacute combined degeneration complicated with neurosyphilis in a 23-year-old female

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月20日

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  • Wei Li,
  • Lirong Wu,
  • Jing Chen,
  • Jun Tang

摘要

Background

Recreational nitrous oxide (N₂O) abuse has become a common health issue in young adults, which can induce subacute combined degeneration (SCD) of the spinal cord. Neurosyphilis has highly similar clinical and imaging manifestations with SCD. The coexistence of N₂O-induced SCD and asymptomatic neurosyphilis is extremely rare and easily overlooked. We herein report such a case to improve clinical diagnosis.

Case presentation

A 23-year-old female presented with 3-month progressive limb numbness and gait instability, with a 6-month history of N₂O inhalation. Spinal MRI showed typical “inverted V-sign” of SCD. Further examinations confirmed asymptomatic neurosyphilis, severe vitamin B12 deficiency and hyperhomocysteinemia. After standard combined treatment, her neurological function was significantly improved with no recurrence during follow-up.

Conclusion

For young patients with spinal cord lesions, screening for N₂O abuse, vitamin B12 and syphilis should be performed simultaneously. Early diagnosis and combined intervention can effectively avoid permanent neurological damage.