A 32-year-old man presents with tingling and inability to walk. Discover the surprising link between his neurological symptoms and a common recreational inhalant.
A 32-year-old man presented with a 6-week history of tingling in his arms and legs and a 2-week history of inability to walk. A positive Romberg test, sensory ataxia, impaired proprioception and vibratory sensation, and preserved nociception were noted. Magnetic resonance imaging of the whole spine showed hyperintensity in the posterior spinal cord from C1 to T12 and hyperintense lesions in the dorsal column on T2-weighted images. A vitamin B12 level was 107 pg per ml (reference value, >231) without macrocytic anemia. Toxicity of which of the following is the most likely cause of this presentation?
What is the most likely diagnosis?
Myelopathy, Nitrous oxide, Sensory ataxia, Subacute combined degeneration, Vitamin B12 deficiency
