What happened?
A 26-year-old woman developed substantial functional decline and neuropathic pain associated with vitamin B12-deficiency spinal cord dysfunction. Her history included nitrous oxide and ketamine use, and spinal MRI was reported as normal despite marked bilateral lower-limb weakness.
Clinical findings
- The presentation included profound bilateral lower-extremity weakness and neuropathic pain.
- Spinal MRI was normal, illustrating that a normal scan does not always exclude clinically important neurological dysfunction.
Rehabilitation described in the report
- A multidisciplinary inpatient programme involved physical therapy, occupational therapy, physiatric oversight and psychiatric support.
- Rehabilitation included progressive gait training, neuromuscular re-education, activities-of-daily-living retraining and energy-conservation strategies.
- Vitamin B12 replacement and neuropathic-pain medication were concurrent medical management, not physiotherapy interventions.
Reported outcomes
- Within nine days, the patient progressed from maximal to minimal assistance for ambulation and transfers.
- At discharge, she walked more than 100 feet using a rolling walker with minimal assistance, and bed mobility and daily activities were nearly independent.
Clinical lessons to consider
- A normal MRI should not override a concerning neurological examination or relevant biochemical findings.
- Rehabilitation planning should integrate neurological recovery, pain, mobility, self-care and psychosocial needs.
Limitations — what this case cannot tell us
- A single case cannot separate the contribution of rehabilitation from vitamin B12 replacement and other medical care.
- The patient's substance-use history is case-specific and should not be assumed in other patients with similar symptoms.
Original source
Fereshteh Kargar Bafrani, Nozima Akbarova, Paul Rutkowski. “Functional Recovery in a Young Adult With Spinal Cord Injury Secondary to Vitamin B12 Deficiency and Substance Use: A Case Report.” Archives of Rehabilitation Research and Clinical Translation, 2025. DOI: 10.1016/j.arrct.2025.100531
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