scholarly journals The Last Laugh – Reversible myeloneuropathy induced by chronic nitrous oxide use

2018 ◽  
Vol 17 (4) ◽  
pp. 232-235
Author(s):  
Gemma Friedlander ◽  
◽  
Thomas Davies ◽  
Keyword(s):  
Nitrous Oxide ◽  
Differential Diagnosis ◽  
Case Report ◽  
Clinical Outcomes ◽  
Sensory Neuropathy ◽  
Subacute Combined Degeneration ◽  
B12 Deficiency ◽  
Full Neurological Recovery ◽  
Recreational Use ◽  
Symptoms And Signs

A previously fit and well 19 year old male presents with a progressive ataxic – sensory neuropathy worsening over 2 – 3 weeks. History and investigations revealed extensive recreational use of nitrous oxide resulting in functional B12 deficiency and consequent subacute combined degeneration of the cord. Abstinence and B12 supplementation resulted in a rapid and full neurological recovery. This case report highlights the importance of considering nitrous oxide abuse in the differential diagnosis of atypical neurological symptoms and signs, and emphasizes the possibility of good clinical outcomes with treatment.

scholarly journals Subacute combined degeneration of the cord secondary to nitrous oxide misuse: No laughing matter

2021 ◽  
pp. 20200179
Author(s):  
Pia F P Charters ◽  
Hamish Duncan Morrison ◽  
Jonathan Witherick ◽  
Susan King
Keyword(s):  
Nitrous Oxide ◽  
Normal Range ◽  
Subacute Combined Degeneration ◽  
Over The Counter ◽  
Aerosol Spray ◽  
Household Item ◽  
Dorsal Columns ◽  
B12 Deficiency ◽  
Hands And Feet ◽  
Recreational Use

Nitrous oxide (N2O) has several traditional uses as a surgical and dental anaesthetic, as well as in aerosol spray propellants. It is the combination of analgesic and euphoric qualities coupled with accessibility as an over-the-counter household item that lends N2O to recreational use. Despite increasing evidence that prolonged use of N2O both medically and as a drug of abuse can cause disabling neurological side-effects, it remains widely used. We present the case of an 18-year-old male who was diagnosed with subacute combined degeneration of the cord (SCDC) secondary to acute, heavy recreational use of N2O. The patient presented with progressive paraesthesia affecting his hands and feet associated with distal weakness. MRI of the cervical spine revealed symmetric bilateral high T2 signal within the dorsal columns extending from the level of C2 to T2 with the inverted ‘V’ sign on axial T2-weighted slices indicative of SCDC. Although vitamin B12 levels were within normal range, marked elevation of methylmalonic acid and homocysteine support the diagnosis of B12 inactivation and functional B12 deficiency, which fully resolved with treatment.

A case report on Subacute Combined Degeneration of spinal cord in children – A rare neurological manifestation in Vitamin B12 deficiencies

2017 ◽  
Vol 6 (12) ◽  
pp. 5562
Author(s):  
Tiana Mary Alexander ◽  
Vineeta Pande ◽  
Sharad Agarkhedkar ◽  
Dnyaneshwar Upase
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Vitamin B12 ◽  
Pernicious Anemia ◽  
Chronic Diarrhea ◽  
Megaloblastic Anemia ◽  
Vegetarian Diet ◽  
Malabsorption Syndrome ◽  
Subacute Combined Degeneration ◽  
B12 Deficiency

Megaloblastic anemia is a common feature between 6 months – 2 years and rarely occurs after 5 years of age, especially in a child consuming non-vegetarian diet. B12 deficiency may occur after 5 years of age because of chronic diarrhea, malabsorption syndrome, or intestinal surgical causes. Pernicious anemia causes B12 deficiency, but nutritional B12 deficiency with subacute combined degeneration causing ataxia is rare.

scholarly journals Subacute Combined Degeneration of the Spinal Cord due to Different Etiologies and Improvement of MRI Findings

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Azize Esra Gürsoy ◽  
Mehmet Kolukısa ◽  
Gülsen Babacan-Yıldız ◽  
Arif Çelebi
Keyword(s):  
Spinal Cord ◽  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Neurological Complication ◽  
Vitamin B12 Deficiency ◽  
Vegetarian Diet ◽  
Mri Findings ◽  
Subacute Combined Degeneration ◽  
B12 Deficiency ◽  
Reversible Condition

Subacute combined degeneration (SCD) is a rare neurological complication of vitamin B12 deficiency, characterized by demyelination of the dorsal and lateral spinal cord. Herein, we describe three cases, who presented with SCD, one related to reduced intake of vitamin B12 because of a vegetarian diet and two related to nitrous oxide exposure during surgery. MR images of our patients revealed symmetrical hyperintense signals in dorsal and lateral columns in T2 weighted series. After treatment with intramuscular B12 injections (1 mg daily for 2 weeks, once weekly thereafter for three months) all patients showed improvement of their symptoms. Abnormalities of the spinal cord on MRI resolved in three months. In conclusion, SCD either due to nitrous oxide exposure or due to reduced intake of vitamin B12 is a reversible condition, when detected and treated early.

scholarly journals Subacute Combined Degeneration and Pulmonary Thromboembolism due to Nitrous Oxide Inhalation for Recreational Use

2018 ◽  
Vol 36 (3) ◽  
pp. 238-240 ◽  
Author(s):  
Seung Jae Kim ◽  
Jongmin Lee ◽  
Yong Sung Kim ◽  
Ki-wook Oh ◽  
Seung Hyun Kim ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Pulmonary Thromboembolism ◽  
Subacute Combined Degeneration ◽  
Recreational Use

scholarly journals Subacute Combined Degeneration with Motor Neuropathy Following Nitrous Oxide Abuse

2021 ◽  
Vol 39 (2) ◽  
pp. 82-84
Author(s):  
Jin Sung Bae ◽  
Jung Im Seok ◽  
Je Wan Lee
Keyword(s):  
Nitrous Oxide ◽  
Magnetic Resonance ◽  
Vitamin B12 ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Magnetic Resonance Image ◽  
Vitamin B12 Deficiency ◽  
Motor Neuropathy ◽  
Subacute Combined Degeneration ◽  
B12 Deficiency

The neurotoxicity of nitrous oxide (N<sub>2</sub>O) is known to be mainly occurred by interference with action of vitamin B12. A 38-year-old male presented with progressive gait instability after recreational inhalational use of N<sub>2</sub>O for 2 months. Although spine magnetic resonance image showed typical subacute combined degeneration, nerve conduction study showed motor neuropathy that is atypical findings of vitamin B12 deficiency. This case suggests N<sub>2</sub>O-induced neuropathy can develop separately from a vitamin B12 deficiency.

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